SECOND OOPY, 







LIBRARY OF CONGRESS. 

Chap,.!.^ Copyright No 

Shelf„..E.3_5> ^ 



UNITED STATES OF AMERICA. 



OBSTETRIC NURSING 



FULLERTON. ' 



BY THE SAME AUTHOR. 

NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 

SECOND EDITION, REVISED. 

i2mo. 300 pages. to Illustrations. Cloth, $1.50. 



*%* The immediate success of Dr. Fullerton's '« Handbook of Obstetric 
Nursing," a fifth edition of which has just been published, has encouraged 
her to prepare this manual on another and very important branch of the 
science and art of nursing. Dr. Fullerton has demonstrated that she not 
only knows what to say, but that she has the happy faculty of saying it in 
a plain, practical style that interests as well as instructs. 

Synopsis of Contents. — The Surgical Nurse — The Germ Theory of 
Disease — Asepsis and Antisepsis — Abdominal Section — The Preparation of 
the Room — The Preparation of Sponges — Sterilization of Instruments, etc. 
— Preparation of the Patient— Preparation of Operator and Assistants — 
The Nurse's Duties During Operation — The Nurse's Duties After Oper- 
ation and During Convalescence — Management of Complications — The 
Pelvic Organs in Women — Diseases of Women — General Nursing in Pelvic 
Diseases — Preparations for Gynecological Examinations — Preparation for 
Gynecological Operations — Preparation of Patient, Operator, and Assist- 
ants — Duties of Nurse During Operation — Special Nursing in Gynecologi- 
cal Operations — Diet for the Sick. 

From The Bulletin of Johns Hopkins Hospital. — " An excellent text-book 
for nurses. * * * The style is pleasant and readable. * * * Such an attempt 
to occupy a new field so successfully carried out is most praiseworthy." 

From the Philadelphia Medical News. — " Dr. Fullerton has clearly dis- 
cerned the requirements in the training of nurses for this special work, namely, 
the inculcation of knowledge that will give an intelligent idea of the work before 
them and the insistence upon habits of promptness and forethought. For both 
the physician and nurse this book presents the important points in a clfear and 
impressive way." 

P. BLAKISTON'S SON & CO., Publishers, Philadelphia. 



A HANDBOOK 



OF 



OBSTETRIC NURSING 



FOR 



NURSES, STUDENTS, AND MOTHERS. 



COMPRISING THE COURSE OF INSTRUCTION IN OBSTETRIC 

NURSING GIVEN TO THE PUPILS OF THE TRAINING 

SCHOOL FOR NURSES CONNECTED WITH THE 

WOMAN'S HOSPITAL OF PHILADELPHIA. 



BY 

ANNA M. FULLERTON, M.D., 

OBSTETRICIAN, GYNECOLOGIST, AND SURGEON TO THE WOMAN'S HOSPITAL OF PHILA- 
DELPHIA, AND FORMERLY PHYSICIAN-IN-CHARGE AND SUPERINTENDENT OF ITS 
NURSE SCHOOL; CLINICAL PROFESSOR OF GYNECOLOGY IN THE 
WOMAN'S MEDICAL COLLEGE OF PENNSYLVANIA. 



FIFTH REVISED EDITION. ILLUSTRATED. 



PHILADELPHIA: 
P. BLAKISTON'S SON & CO., 

IOI2 WALNUT STREET. 
1899. 



• Mtf 



25891 



Copyright, 1899, by Anna M. Fullerton, M.D, 



TWO COPIES 






LC Control Number 



PRESS OF WM. F. FELL & CO., 
1220-24 Sansom Street, 

PHItADELPHIA. 







tmp96 027851 



THIS LITTLE BOOK 

IS DEDICATED 

TO 

2>t\ Bnna }£♦ JSroomall t 

PROFESSOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE 
OF PENNSYLVANIA, 

IN APPRECIATION OF 

HER ABLE AND FAITHFUL WORK 

AS A TEACHER. 



PREFACE TO FIFTH EDITION. 



The excellent results to be attained by an adherence 
to the methods advocated in this little book, and ob- 
served in the obstetric work of the Woman's Hospital, 
will prove the value of cleanliness, antisepsis, and eternal 
vigilance on the part of the nurse, in averting the dan- 
gers of childbirth, and reducing the mortality of early 
infancy. In the fifth, as in former editions of my work, 
I have made every effort to bring its teachings up to the 
requirements of modern practice. An especial effort has 
been made to consider in detail the needs of the young 
infant whose hold on life in the earlier days of its exist- 
ence is slender. The latest and most approved methods 
in the application of disinfectants and antiseptics to 
obstetric practice have been supplied in this revision of 
the work, as many other points marking the progress of 
the science of nursing. 

The grave responsibilities so often thrown upon the 
trained nurse necessitate a most thorough knowledge 

ix 



X PREFACE TO FIFTH EDITION. 

upon her part of the conditions she may be called upon 
to manage. It is for her chiefly that this little book has 
been written. 

The importance, however, of a thorough understand- 
ing of the many little details of scientific nursing on 
the part of the physician, leads me to trust that the 
work may be of value to physician as well as nurse; 
and since both of these must have the entire support, 
sympathy, and assistance of the patient in their efforts 
for her well-being, the directions herein given as to pre- 
parations to be made, and rules of action to be observed, 
will, it is hoped, enable the patient to work in harmony 
with those who are working for her good. 

ANNA M. FULLERTON. 
123 S. i6ih St., Philadelphia. 
Feb7'uary g, i8gg. 



CONTENTS 



CHAPTER I. 

PAGE 

The Pelvis and Genital Organs, 17 

CHAPTER II. 

Signs of Pregnancy, 25 

CHAPTER III. 
Management of Pregnancy, 32 

CHAPTER IV. 
Accidents of Pregnancy, 53 

CHAPTER V. 
Germs and Antisepsis, 59 

CHAPTER VI. 
Application of Antisepsis in Confinement Nursing, 66 

CHAPTER VII. 
Preparations for Labor, 81 

CHAPTER VIII. 

Signs of Approaching Labor and the Process of Labor, 92 

xi 



XU CONTENTS. 

PAGE 

CHAPTER IX. 
Duties of the Nurse During Labor, 98 

CHAPTER X. 
Accidents and Emergencies of Labor, 115 

CHAPTER XL 
Management of the Lying-in, 134 

CHAPTER XII. 
Care of the New-born Infant, 171 

CHAPTER XIII. 
Characteristics of Infancy in Health and Disease, 205 

CHAPTER XIV. 
The Ailments of Early Infancy, 217 



LIST OF ILLUSTRATIONS 



FIG. PACxE 

1. Normal Pelvis, 1 8 

2. External Genitalia, 19 

3. Cavity of the Uterus and Fallopian Tubes, 21 

4. Abdominal Belt, ... 35 

5. Spiral Reverse Bandage of Lower Extremity, 40 

6. Nipple Protector, 44 

7. Jenness-Miller Chemilette, 45 

8. Jenness-Miller Divided Skirt, . 45 

9. Union Undergarment, 46 

10. Jenness-Miller Leglette, 46 

11. The Equipoise Waist, 48 

12. Formaldehyd Gas Generator, 78 

13. Occlusion Dressing (Dr. Garrigues'), 83 

14. Nightingale Wrap, 85 

15. Byrd-Dew Method of Artificial Respiration, 119 

16. Schultze's Method of Resuscitation (First Movement), . . . . 121 

17. Schultze's Method of Resuscitation (Second Movement), ... 122 

18. Prochownick's Method of Resuscitation, 124 

19. Prochownick's Method of Resuscitation, 124 

20. Position of Patient in Hemorrhage after Labor, 130 

21. Nipple Shield, 147 

22. Variously Shaped Nipples, 148 

23. Figure-of-eight Bandage of One Breast, 150 

24. Figure-of-eight Bandage of Both Breasts, 151 

25. Garrigues' Breast Bandage, 15 1 

26. Breast-pump, 152 

27. Handkerchief Bandage for Breast, 154 

xiii 



XiV LIST OF ILLUSTRATIONS. 

FIG. PAGE 

28. Worcester's Y-Bandage, 155 

29. Obstetrical Breast Support, 156 

30. Home-made Bath-tub and Crib, 179 

31. Lactometer, 186 

32. Sterilizer (Dr. Louis Starr), . 199 

33. Graduated Nursing Bottle (Dr. Louis Starr), 201 

34. Rubber Nipple (Starr), 203 

35. Diagram Showing Eruption of Milk Teeth, 215 

36. Tarnier's Couveuse, . 218 

37. Auvard's Couveuse (Interior View), 219 

^8. Auvard's Couveuse (Exterior View), 220 

39. Lion Incubator, 222 

40. Swaddled Baby, 224 

41. Single-bulb Syringe (Starr), 237 



OBSTETRIC NURSING. 



CHAPTER I. 

THE PELVIS AND GENITAL ORGANS. 

The Pelvis is that part of the skeleton found between 
the lower end of the spinal column and the thigh bones. 
It consists of four bones — the sacrum, the coccyx, and 
the right and left innominate or hip bones. These 
bones form a canal through which the child passes dur- 
ing labor. 

Measurements, or Diameters, are taken from certain 
parts of the pelvis to determine the capacity of this 
canal. It is important that every pregnant woman 
should have her pelvis measured by the physician whom 
she expects to have attend her in labor, in order that it 
may be discovered whether her pelvis is at all under 
size, so that special precautions may be taken in time to 
prevent difficulty in the delivery. These measurements 
should be taken not later than the seventh month of 
pregnancy, as it may be desirable, for the sake of both 
mother and child, that the physician should induce 
premature labor. 

The Canal of the Pelvis contains the internal organs 

17 



i8 



OBSTETRIC NURSING. 



of generation — viz., the uterus, Fallopian tubes, and 
ovaries; and the bladder and rectum besides. 

The External Organs are called the " pudenda/' or 
" vulva." 

Immediately above the pubic bone, or anterior border 
of the pelvis, is a cushion of fat, usually covered with 
hair. This is called the " mons veneris. " On each side of 




Fig. i. — Normal Pelvis. 



the opening of the vulva are the " labia majora," or 
large lips. Lying beneath these and concealed by them, 
in young women, are two thin folds of flesh, named the 
" labia minora," or " nymphae." They join together 
above, and at their junction is a small projecting body 
called the " clitoris." The small triangular space between 
the clitoris and the nymphae is the " vestibule." 

The opening of the urethra (the " meatus urinarius "), 



THE PELVIS AND GENITAL ORGANS. 



19 



through which the urine escapes from the bladder, is in 
the middle of the lower border of the vestibule. It is 
very important that the nurse should know the exact 




Fig. 2. — External Genitalia. 

1. The right labium majorum. 2. The fourchette. 3. Right nympha. 4. Clitoris, 
v Urethral orifice. 6. Vestibule. 7. Orifice of vagina. 8, 8. Hymen. 9. Ori- 
ice of duct of vulvo-vaginal gland. 10. Mons veneris. 11. Anal orifice. 



I 



position of the meatus urinarius, as she will frequently 
be called upon to pass the catheter. 

Below the vestibule is the orifice of the " vagina," the 
canal leading to the uterus, or womb. In virgins a deli- 



20 OBSTETRIC NURSING. 

cate membrane, usually crescentic in shape, blocks the 
entrance to the vagina. This is the " hymen." 

The hymen is usually ruptured at marriage, but a 
woman may be a virgin yet have no hymen ; in some 
cases it persists even after marriage, and offers an ob- 
struction at childbirth. A woman who has borne chil- 
dren has a few fleshy projections at the orifice of the 
vagina, the only remains of the hymen, called the " car- 
unculae myrtiformes." Between the vulva and the anus 
is a mass of flesh, the space on the surface measuring 
one. and one-half inches in length. During the birth of 
the child this becomes greatly distended, and thins like 
rubber. This is the "perineum." It may be torn during 
labor to a greater or less extent ; sometimes it is com- 
pletely torn into the bowel. That part of the perineum 
in the virgin which forms the posterior border of the 
vulva is called the " fourchette." It is merely a fold of 
skin, and is almost always torn in a first labor. Behind 
the perineum is the " anus," or orifice of the rectum, the 
lower part of the bowel. 

The Vagina is a canal connecting the external with 
the internal organs of generation. The uterus is at the 
top of the vagina. In front of the uterus is the bladder, 
and behind and to the left the rectum. 

A secretion of mucus keeps the vagina moist. There 
should, however, be no discharge in a perfectly healthy 
woman. During pregnancy, and as a result of ill 
health or local inflammation, the natural secretion may 
be greatly increased, and the patient is then said to have 



THE PELVIS AND GENITAL ORGANS. 



21 



" the whites." In labor the discharge is very greatly 
increased, so as to aid the birth of the child. 

The Uterus is a pear-shaped organ, three inches in 
length, one and one-half inches in breadth, and about one 
inch in thickness. It weighs a little over an ounce in 
its normal condition in a virgin. After child-bearing it 
remains larger and heavier than before. That portion 
of the uterus which communicates with the vagina is 



H 



H 



J8&> 




Fig. 3. — Cavity of the Uterus and Fallopian Tubes. 
Superior border of fundus of womb. B. Cavity of the womb. C. Cavity of the 
neck of the womb. D, D. Canal of the Fallopian tube. E, E. The fimbriated 
extremities. F, F. The ovaries. G. The cavity of the vagina. H, H. The 
ovarian ligaments. I, I. The round ligaments. 



called the " neck, or cervix." The chief portion of the 
organ above this is called the body, and the rounded 
upper surface the fundus. The opening in the cervix 
which communicates with the vagina is called the " os 
uteri." That portion of the cervix in front of the os 
uteri is the anterior lip, while that part which lies behind 
is the posterior lip. 

The Fallopian Tubes are two canals which pass 



22 OBSTETRIC NURSING. 

from each side of the upper portion of the uterus. 
They are from three to four and one-half inches long, 
and will admit the passage of a bristle. Each ends in 
a trumpet-shaped opening surrounded by a fringe of 
small projections called " fimbriae." This is called the 
fimbriated extremity. When the ovum (or egg) escapes 
from the ovary, it is received by the Fallopian tube and 
reaches the cavity of the uterus in this way. 

The Ovaries are two small flattened bodies about an 
inch long and half an inch thick. They lie about an 
inch from the fundus of the uterus on each side, in the 
folds of the broad ligament. The broad ligaments are 
folds of peritoneum, a thin glistening membrane which 
covers the uterus and all the pelvic organs, and by 
means of which the uterus is s.uspended in the pelvis. 
The bladder and rectum being covered with the same 
tissue, there is an intimate connection between the three, 
so that if one is deranged the others are likely to be also. 

The Breasts are considered as belonging to the ex- 
ternal organs of generation. They are two glands situ- 
ated on the front of the chest, one on each side of the 
breast-bone. They vary in size and shape in different 
women, and during pregnancy they enlarge greatly. 
They secrete milk for the nourishment of the child. 
The nipple at the apex of the gland is a conical-shaped 
projection. The milk ducts all come toward it from the 
different parts of the breast and open on its surface. The 
areola is a pink or brown circle which surrounds the 
nipple. 



THE PELVIS AND GENITAL ORGANS. 23 

There is an intimate connection between the breasts 
and the uterus. Pain in the breast may be the result of 
disease of the uterus. The secretion of milk is called 
"lactation." '" 

Menstruation is a bloody discharge from the uterus 
every month. It begins usually about the age of four- 
teen and recurs every month, except during pregnancy 
or while a woman is nursing. There are occasional ex- 
ceptions to this rule. It ceases at the change of life, or 
menopause (usually between forty-five and fifty). 

At puberty — that is, when this function first appears — 
the girl becomes a woman, the breasts enlarge, and the 
pelvis increases in size. The organs of generation be- 
come ready to perform the functions of reproduction. 
The menstrual flow recurs every twenty-eight days and 
lasts about four days. The quantity of blood lost at a 
period is from four to eight ounces. Different women 
vary much in this respect. The discharge is blood 
mixed with mucus. Its color is dark red. Any pecu- 
liarity in color, or the appearance of any clots in the dis- 
charge, will need to be noticed by the nurse and the 
discharge kept for the doctor's inspection. There is 
usually a feeling of discomfort at the menstrual period, 
with headache, pains in the back, breasts, etc. These 
symptoms are more severe in some women than in 
others. The periodic congestion of the uterus, which 
results in the production of the menstrual flow, is prob- 
ably associated with the ripening of the ova or eggs in 
the ovaries. It has been found, however, that the ova 



24 OBSTETRIC NURSING. 

may escape from the ovaries and be carried into the 
uterus through the Fallopian tubes independently of 
menstruation. The ova that do not become impregnated 
are simply carried away by the natural discharge. 

Conception most usually takes place immediately or 
very soon after a period. This is not an invariable rule, 
as women have become pregnant before menstruation 
has been established, or even after the menopause. 
They may also become pregnant while nursing. The 
principal disorders of menstruation are : 

Dysmenorrhea, or painful menstruation ; 

Menorrhagia, or excessive flow at the period ; 

Amenorrhea, or suppression of the menstrual flow : 
and 

Metrorrhagia, the occurrence of hemorrhage between 
the menstrual periods. . 

The causes of these disorders are very numerous and 
must be determined by a physician. 

A nurse is so often questioned on these points that it 
is well for her to have information concerning them. 
Always endeavoring to discourage the inquisitiveness of 
mere prurient curiosity, she should aim to give wise 
counsel concerning matters of which her patient may 
hesitate to speak to her physician. In doing so the 
nurse should, however, speak to the physician of any 
matters of importance concerning the condition of the 
patient which she may thus learn, and ask his counsel 
as to the advice she should give. 



CHAPTER II. 
SIGNS OF PREGNANCY. 

The Signs of Pregnancy may be divided into three 
classes : the suspicious, the probable, and the certain. 

Under the head of suspicious signs may be classed the 
many nervous sensations which are apt to accompany 
early pregnancy ; as, general discomfort, sudden changes 
of temperature, headache, toothache, giddiness, faint- 
ness, changes in disposition, perverted appetite, etc. 

Of the probable signs one of the earliest and most con- 
stant is the stoppage of the monthly flow in a person who 
has been regular. This may be, however, caused by 
other conditions than pregnancy. Thus, change in 
one's mode of living, a new climate, or general ill 
health may produce the same result. In the early 
months of marriage we may also have an irregularity 
in menstruation where there is no pregnancy. On the 
other hand, in rare instances, we may have the monthly 
flow persisting for some months or throughout the 
entire pregnancy. It is then generally scanty and short 
in duration. 

A deepening in the color of the vagina and vulva, by 
which they take on a purplish hue, is another sign, and 

25 



26 OBSTETRIC NURSING. 

is caused by the enlargement of the blood-vessels and a 
stoppage of the circulation, due to pressure from the 
enlargement of the uterus. This coloration may be 
caused to some extent by tumors. 

Increase in the size of the breasts occurs in the early 
months of pregnancy with a deposit of coloring matter 
in the areola, or ring which surrounds the nipple. 
Some of this coloring matter seems to extend irregu- 
larly over the outer margin of the ring, and is called 
the " secondary areola " or " areola of Montgomery." 
With this distention of the breasts there is also a secre- 
tion found in them — a watery fluid, sometimes yellowish 
in color, known as " colostrum," which appears about 
the third month. 

Temporary distention of the breasts, with the accumu- 
lation of this secretion, may occur in a slighter degree 
as an accompaniment of menstruation, or it may persist 
for a long time after a woman has stopped nursing her 
infant. 

Enlargement of the abdomen , which begins about the 
end of the third month of pregnancy, is another impor- 
tant sign. Yet this may also be caused by tumors, or 
by flatulence, or the deposit of fat in the abdominal 
walls. 

Marks upon the abdomen, due to the rapid stretching 
of the skin, sometimes occur in great numbers, and are 
called " strice" owing to the fact of their resemblance to 
the marks left by whip-lashes. These marks sometimes 
extend down upon the thighs. This, too, may be 



SIGNS OF PREGNANCY. 2*] 

caused by tumors. The " brown line " of pregnancy is 
the deposit of pigment in the median line of the abdo- 
men. This may exist when there is no pregnancy, as 
also may the peculiar browning of the skin found in 
irregular patches over the face, particularly on the fore- 
head, and called the " mask of pregnancy." 

"Morning Sickness" another sign, begins early in the 
second month or at the time of the first missed period. 
It is generally confined to the first three months, and is 
largely a nervous symptom. It varies much, however, 
in degree and time of occurrence. Sometimes it is 
simply a slight feeling of sickness at the stomach occur- 
ring early in the morning ; again, it may persist through- 
out the entire day, or it may occur one day and not 
again for several days. Sometimes it continues through- 
out the entire pregnancy, and is then dangerous because 
of the constant loss of food. Sometimes it occurs early 
in the pregnancy, then disappears to reappear in the 
last month, when there is direct pressure upon the 
stomach. 

" Quickening " — or the appreciation of the movements 
of the child by the mother — is another probable sign, 
and is first experienced about the middle of pregnancy. 
A woman who has previously borne children feels this 
sensation about two weeks earlier than one pregnant 
for the first time. 

There are other probable signs of pregnancy which 
would come only under the observation of the physician. 
As they require considerable knowledge of obstetrics, 



28 OBSTETRIC NURSING. 

and skill in the conducting of an examination for the 
discovery of pregnancy, we will not do more than refer 
to them here. Hegar's sign is the softening of the 
lower portion of the posterior wall of the uterus, and the 
increase of the antero-posterior diameter of that organ, 
as discovered by what is known as bi-manual palpation 
— one finger of the examiner resting over the posterior 
wall of the uterus through the rectum, while the other 
hand makes pressure over the lower part of the ab- 
domen. 

Another sign is that afforded by the thermometer, 
when its bulb is carried within the cervical canal. If 
pregnancy exist, the temperature is said to be from a hall 
to one degree higher than in the vagina. 

The pulse of a pregnant woman is said also to show 
less variation from change in position than that which 
occurs in the non-pregnant state. Thus, the change 
from lying to sitting or standing does not cause a quick- 
ening, such as is usually observed in the non-pregnant 
state. 

The uterine souffle is a blowing sound which is sup- 
posed to occur in consequence of the enlargement of the 
blood-vessels of the uterus, and which, therefore, cor- 
responds in its rhythm with the radial pulse of the 
patient. This must not be confounded with the funic 
souffle, a blowing sound which sometimes occurs in the 
vessels of the cord, and which is synchronous with the 
fetal pulse, therefore about twice as rapid as the mother's 
pulse. 



SIGNS OF PREGNANCY. 29 

When the uterus is large enough to be felt through 
the abdominal walls, palpation over it is apt to cause a 
contraction, which is indicated by a temporary hardening. 
This is another indication of pregnancy. 

The positive signs of pregnancy as agreed upon by 
most obstetricians are but two : the direct appreciation 
of the parts of the child by touch, and the " fetal pulse," 
or heart sounds of the child. The " fetal pulse " is, as a 
rule, twice as fast as the pulse of the mother. It is 
hardly strong enough to be heard, even by experienced 
ears, much before the 5th month — or end of the 20th 
week ; rarely heard well before the 24th week. 

Methods of Determining Date of Confinement. — 
The ordinary method of reckoning the probable date 
of confinement is as follows : Learn on what day the 
last monthly flow began, then count three months back- 
ward (or nine months forward) and add seven days. 
For example, say that a woman was unwell last on 
March 15: counting three months back gives December 
15 ; add seven days, and we have December 22 as the 
probable date of her confinement. All methods of 
reckoning are only approximate. It is best to consider 
the date calculated as the middle of a period of two 
weeks, within which labor may occur at any time. 
When, for any reason, it is impossible to make the cal- 
culation by this method, it may be computed by adding 
four and a half months to the date of quickening in the 
case of a woman pregnant for the first time, and five 



30 OBSTETRIC NURSING. 

months in the case of one who has previously borne 
children. 

The third method, that of adding forty weeks, or ten 
lunar months, to the date of conception, is too uncertain 
to be of much practical use. Examination of the patient 
by an intelligent physician who knows and appreciates 
the distinctive signs of the several months offers a 
fourth method of computing the date of pregnancy. 

Numerous tables for a rapid computation of the date 
of confinement have been made. The accompanying 
table is one much used. By taking the upper figure in 
each pair of horizontal lines as representing the date ot 
the first day of the last menstrual period, the figure im- 
mediately beneath it will represent the probable date of 
confinement. 



SIGNS OF PREGNANCY. 



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CHAPTER III. 
MANAGEMENT OF PREGNANCY. 

The management of pregnancy consists, for the most 
part, in greater attention to the laws of health. The 
increased activity of all the organs of the body, together 
with the disturbances caused by pressure, necessitates 
this. 

Constipation is an almost invariable accompaniment 
of pregnancy. In the early months it is a sympathetic 
condition ; later, the effect of direct pressure upon the 
bowels. It is also, undoubtedly, in part due to the want 
of exercise. 

The treatment of constipation is the same as in other 
conditions, except that only mild laxatives are used. 
Regularity in attention to the bowels, a glass of cold 
water at night and again in the morning, liquids (either 
milk or water), not taken with the meals, but in the in- 
tervals, a teaspoonful of common salt in the water occa- 
sionally, the use of uncooked fruit and coarse bread, the 
avoidance of starches and fine flour— all these are help- 
ful in overcoming this condition. There is an objection 
to the use of sugared fruits, as confections of fruit, 
senna leaves, etc., because of their liability to disturb 

32 



MANAGEMENT OF PREGNANCY. 33 

the stomach. Prunes are, perhaps, the least objection- 
able; licorice powder, because of the senna which it 
contains, is apt to cause griping pains. Rhubarb is, 
perhaps, the best of the mild laxatives. A small piece 
of rhubarb root, the size of a pea, may be taken at 
night, followed by a glass of water. If there is an objec- 
tion to its taste, it may be taken in pill form. Cascara 
sagrada is also useful. 

Cream of tartar, a half a teaspoonful being taken at 
night in a cup of cold water, is often efficient. In some 
cases it may be necessary to repeat the dose in the 
morning. 

Massage of the abdomen, so efficient in the manage- 
ment of constipation, should never be resorted to in the 
pregnant state, as it is apt to excite uterine contractions 
and may lead to miscarriage. There is an objection to 
the too frequent use of enemata on the same ground ; 
also, the habit is thus acquired of depending upon this 
stimulus, and overdistention of the bowel is the result. 
It may be necessary, however, occasionally to alternate 
an enema with a laxative, especially when the patient 
suffers from piles. 

Diarrhea is rather a rare disturbance of pregnancy, 
but it sometimes occurs as a direct result of constipa- 
tion — small, hardened masses forming in the bowel, 
known as " scybala," which produce an irritation of the 
mucous lining. The use of rhubarb night and morning, 
in the manner described above, until all the masses are 
removed from the bowels, will serve to check the 
3 



34 OBSTETRIC NURSING. 

diarrhea. Should the condition be due to other causes, 
as indigestion, etc., appropriate remedies will have to be 
prescribed by a physician. 

Changes in the Urinary Organs are mainly due to 
direct pressure. In the first three months of pregnancy 
there is direct pressure on the bladder, hence great irri- 
tation, due to interference with the distention of the 
bladder, producing a constant desire to pass water. For 
this the recumbent position is the only help. The 
uterus rises in the abdomen at the end of the third 
month, and the bladder being thus relieved from pres- 
sure, this symptom passes away. 

The tendency from the fourth to the ninth month is to 
the accumulation of urine, because there is less than the 
proper irritability of the bladder, the organ being flat- 
tened between the uterus and the abdominal walls, and 
its walls thereby suffering a partial paralysis. 

In the last month there is incontinence of uri?ie, be- 
cause the pressure is so great that there is no room for 
the accumulation of urine. 

During labor there is pressure upon the neck of the 
bladder and urethra, leading to retention. This may 
exist for the last two weeks of pregnancy. Necessity 
for the use of the catheter is confined, as a rule, to this 
period. The distention of the bladder may impede 
labor. With the drawing up of the uterus the bladder 
is drawn up and the urethra elongated, hence the use of 
the long rubber catheter, known as the English cathe- 
ter, will be necessary. Nos. 8 and 9 are those ordinarily 
used. 




MANAGEMENT OF PREGNANCY. 35 

Sometimes irritability of the bladder is due to exces- 
sive acidity of the urine. A. physician will generally 
prescribe some alkali to overcome this condition, as a 
drop of liquor potassa in a tablespoonful of milk once 
in three or four hours, or the 
use of mucilaginous drinks, 
as flaxseed tea, barley water, 
milk, etc., may relieve the 
distress. 

When the abdominal walls 
are much stretched and the "~~*^^ig|^y 

uterus falls upon the bladder, fig. 4.— abdominal belt. 
this may be remedied by the 
use of the binder or an abdominal supporter. 

Incontinence of Urine leads to the excoriation and 
reddening of the parts about the vulva. Frequent 
washing with warm water and borax or pure Castile 
soap relieves the irritation. Diachylon or zinc ointment 
is best when an ointment is needed. 

Incontinence is sometimes the result of overdisten- 
tion of the bladder. Here the use of the catheter is 
indicated. 

A nurse, unless thoroughly experienced, should never 
attempt to pass the catheter in the case of a pregnant 
woman, as serious injury may be done to the soft parts 
in a bungling attempt. In all cases she should have the 
sanction of the physician before so doing. 

The Kidneys are especially subjected to pressure 
from the seventh to the ninth month of pregnancy. A 



36 OBSTETRIC NURSING. 

passive congestion is thus produced, which may lead to 
the occurrence of albuminuria, or albumin in the urine. 
This is an evidence of a drain upon the blood which 
the physician needs to watch very carefully. It is cus- 
tomary, therefore, for physicians to examine the urine 
of patients whom they expect to attend at least once a 
week, from the seventh month on to the termination of 
pregnancy. 

Examination of Urine. — The urine to be obtained 
on first emptying the bladder in the morning, and before 
breakfast, if possible, is the most satisfactory for examin- 
ation. When a small quantity of albumin is present in 
urine, it is often increased after a meal. The same is 
true of sugar. A specimen obtained by the use of the 
catheter is the best for the purpose, if the patient be 
troubled by a discharge from the vagina. 

It is important also to note the amount of urine passed 
daily during pregnancy. The nurse in attendance upon 
a patient who is awaiting her delivery should make a 
daily record of the amount passed, to keep the physician 
informed as to the work done by the kidneys. 

The average quantity of urine excreted in twenty-four 
hours in health during the non-pregnant state is about 
three pints, or fifty ounces. A clean vessel, set aside for 
the patient's exclusive use, should be used by her each 
time that the bladder needs to be emptied during the 
entire twenty-four hours. The nurse then measures the 
amount, using for the purpose a graduate set aside for 
the work, or some other vessel of known capacity. 



MANAGEMENT OF PREGNANCY. 37 

The color of the urine will need to be noted by the 
nurse in her record. The natural color is clear, pale 
yellow, or amber. Substances taken by the patient, as 
food or medicine, or conditions of disease may cause the 
color to vary, or render the urine turbid. # 

There is a natural increase in the amount of urine 
passed by a pregnant woman, but the increase is mainly 
in the water. Therefore the urine will be lighter col- 
ored than usual. 

The reaction of the urine should be acid. Small strips 
of blue and pink litmus-paper (that is, paper colored by 
a delicate coloring matter known as litmus) should be 
kept on hand for the purpose of testing the urine while 
fresh. When a strip of the blue litmus-paper dipped 
into the urine turns pink, we know the urine is acid ; 
when the pink paper is made to turn blue, the urine is 
alkaline ; when no impression is made on either, it is 
neutral. 

Usually the estimate of the amount passed in twenty- 
four hours, and a record of the color and the reaction, 
cover the requirements of a nurse's observations of the 
urine. Sometimes, however, a physician requires the 
nurse to test daily for the presence of albumin. This test 
is effected as follows : Fill a test-tube one-quarter or 
one-third full of clear urine (after filtering the urine, if 
cloudy, through filter paper). If the urine is not dis- 
tinctly acid in reaction, add a few drops of acetic acid. 
Boil the fluid over an alcohol lamp, directing the flame 
to the upper part of the urine. If a cloudiness appears, 



38 OBSTETRIC NURSING. 

it is thus at once contrasted with the clear urine of the 
lower layer, as the tube is held up toward the light. 
This cloudiness may be due to albumin or earthy phos- 
phates. A few drops of nitric acid, if added, will make 
triphosphates disappear but not the albumin. 

Leucorrhea, a discharge from the vagina, commonly 
known as " the whites," is much increased often during 
pregnancy, and is due to the greater activity in the secre- 
tion of all the mucous membranes. If a vaginal dis- 
charge be of a white, yellow, or green color, it indicates 
inflammation of the vagina itself. The discharge, on 
reaching the vulva and coming in contact with the air, 
decomposes and becomes irritating. Cleanliness is im- 
portant in overcoming the effects of this. The itching 
induced by it is sometimes very obstinate, and generally 
worse at night. A solution of borax and water for 
bathing the parts, or carbolic acid, 15 to 20^ to a pint 
of water, will often give relief. Should vaginal injections 
be ordered by the physician, they should be given with 
great caution. A fountain syringe should be used, 
which produces a continuous stream, and the rubber 
bag or reservoir containing the water should not be held 
higher than two feet above the level of the bed or couch 
on which the patient lies. The interrupted stream 
should never be employed. In some conditions of ex- 
cessive discharge the physician may prescribe tannic 
acid suppositories to be used nightly in the vagina. 
After a thorough drying of the parts surrounding the 
vulva, they may be dusted with a powder consisting of 



MANAGEMENT OF PREGNANCY. 39 

one part powdered camphor to four parts starch. This 
often gives great relief. Calomel powder may be used 
in the same way. 

Hemorrhoids, or Piles, are often very troublesome 
during the latter part of pregnancy. Lying down im- 
mediately after a movement of the bowels, and remain- 
ing in the recumbent position for ten to fifteen minutes, 
will tend to relieve them, also care in obtaining a daily 
evacuation of the bowels, and the use of means to secure 
as soft a movement as possible. Should the piles come 
down, they should be fomented by cloths wrung out in 
hot water, to which a little Pond's Extract or fluid ex-, 
tract of hamamelis maybe added, — one tablespoonful, or 
two, to one pint of water, — and when shrunken, anointed 
with cold cream or cosmoline, or any ointment prescribed 
by the physician, and returned into the bowel. 

Sometimes the case is so aggravated as to necessitate 
keeping the patient in bed for a time. A physician 
should, of course, be consulted about the treatment. 

Swelling and Pain of the external organs of gene- 
ration and of the lower limbs, resulting from pressure 
and the overdistention of the blood-vessels, is best re- 
lieved by the recumbent posture. 

Should the veins of the legs be much enlarged or the 
feet swollen, the patient should have compression made 
over them by the application of a bandage (the spiral 
reverse of the lower limb), or she should wear an elastic 
stocking, such as may be obtained of any good instru- 
ment maker. For the bandage the best material is 



40 



OBSTETRIC NURSING. 



flannel cut bias, the width being about three inches. 
The bias bandage makes more even compression. Great 




Fig. 5.— Spiral Reverse Bandage of Lower Extremity. 



harm may result from the neglect of enlarged veins, as 
they sometimes become so distended as to burst. Prof. 
T. S. K. Morton has devised a method of putting on a 



MANAGEMENT OF PREGNANCY. 4 1 

spiral bandage of the lower extremity, which retains its 
place better than that just described, which is apt to 
loosen when the patient moves about. Dr. Morton 
begins the application of his bandage as in the ordinary 
spiral reverse bandage of the lower limb, but carries 
oblique turns up and down the limb until its surface is 
entirely covered, in place of making reverses. When 
this bandage is further secured in place by carrying a 
running line of stitches up both the inner and outer side 
of the limb, it keeps its place perfectly and is quite as 
serviceable as an elastic stocking. 

Pain caused by the stretching of the walls of the 
abdomen may be relieved by thorough inunction of the 
skin. Cotton-seed, olive, or cocoanut oil may be used 
for the purpose. 

Severe pains in the back, neuralgic in character and 
so severe sometimes as to prevent the patient from 
sleeping, may yield to change of position, relieving 
pressure. Rubbing with soap liniment, volatile liniment, 
whisky, or any liniment not too active, is helpful. 
Warm hip-baths may sometimes be prescribed by a 
physician. 

The Salivary Glands are in some cases very active 
during pregnancy, inducing so excessive a secretion of 
saliva as to cause the patient great annoyance. This 
trouble is generally very intractable, and may refuse to 
yield to all treatment, ceasing only with parturition. 
Astringent washes, as of tannic acid, alum, myrrh, etc., 
may be tried, as also the use of pieces of ice. Physi- 



42 OBSTETRIC NURSING. 

cians sometimes use atropia in small doses. Its use 
requires careful watching. 

Bad Teeth, which occur so often during pregnancy, 
are said to be due to acidity of the saliva. A little 
baking soda or prepared chalk placed in the mouth at 
night will counteract the effect of this acidity when it 
exists. The question is often asked whether there is 
any danger in having the teeth filled or attended to dur- 
ing pregnancy. There is always some danger, because 
a certain amount of nerve-irritation is the result. If 
the patient be suffering, however, it is better to have 
them filled by a temporary rubber filling, which causes 
little pain or irritation, than to lose rest in consequence 
of toothache. Extraction of the teeth should only be 
allowed when absolutely essential. If the pain be sim- 
ply a neuralgic pain, it is better to wait. 

Vomiting is, as has been said in the preceding chap- 
ter, a most common accompaniment of pregnancy. It 
more frequently exists, perhaps, with the first pregnancy 
than any other. The act is accomplished, as a rule, 
without much effort. Diet seems to have little effect 
upon it. Various articles have been recommended for 
it, as rice water, beef-tea, barley water, the various 
gruels, the yolk of a hard-boiled egg, scraped beef in 
the form of sandwiches, ice-cream, cracked ice, etc. In 
some cases one or another of these seems to relieve the 
irritation. A cup of coffee, weak tea, or milk, taken 
warm early in the morning before the patient raises her 
head from the pillow, will often act as a preventive. 



MANAGEMENT OF PREGNANCY. 43 

In extreme cases of vomiting rectal feeding must be re- 
sorted to. In obstinate vomiting it is important that 
the physician should examine for the position of the 
uterus or the existence of ulcerations or erosions. 

It must not be forgotten that the Constant loss of 
food may be so great a drain upon the patient's strength 
as to endanger her life. As this symptom is so largely 
sympathetic, the proper use of bromides or other nerve 
sedatives prescribed by a physician may be of great use 
in checking it. 

Care of the Breasts in a pregnant woman necessi- 
tates careful attention to the prevention of compression. 
Full development should be permitted by the looseness 
of the clothing. The importance of the proper dress- 
ing of growing girls cannot be overestimated in this 
connection. Did mothers realize the evils — of which 
the atrophy of the breasts is but one — resulting from 
tight lacing, there would be fewer unhealthy women 
and fewer mothers unable to nurse their offspring. The 
nipples should be prevented from rubbing, and the skin 
over the nipples should be strengthened by using the 
nipple-bath — filling a small, wide-mouthed bottle one- 
third full of cold water and inverting it over the nipples 
daily, from five to ten minutes at a time. Sometimes a 
little cologne-water or alcohol is added to the nipple- 
bath, or, better still, borax in the proportion of one 
tablespoonful to the pint of water. Keeping off scabs 
and concretions of various kinds from the surface of the 
nipples by the use of a little oil is also admissible. This 




44 OBSTETRIC NURSING. 

keeps the skin pliable. The use of the nipple-protector, 
which will be referred to more fully in the chapter on 
the management of the lying-in, is of great importance 
where there is a tendency to flattening of the nipple, 
to remove the pressure of the clothing. Drawing out 

the nipple gently between the thumb 
and finger is also helpful in over- 
coming this tendency. 

The Clothing of a pregnant 
woman should be worn loose from 

Fig. 6.— Nipple Pro- ... 

tector. the very beginning, both because 

the breasts begin to enlarge early 
and corsets interfere with their development, and be- 
cause any amount of pressure upon the intestines tends 
to produce uterine displacements, which are especially 
dangerous during pregnancy, as they predispose to 
abortion. The clothing should all be supported from 
the shoulders. 

Many new dress reform systems are now in vogue, 
having for their object the great desideratum of adjust- 
ing woman's dress so as to make it both healthful and 
beautiful. Fortunately, in this enlightened age ideas of 
physical culture are so modifying old-time ideas ot 
beauty that the wasp waist, the multitudinous and vol- 
uminous skirts, the awkward and deforming bustle, the 
high-heeled boot, are fast becoming relics of the past. 
Among the dress reform systems now in existence there 
is none so fully meets my views of healthful and beau- 
tiful dressing as the Jenness- Miller System. But few 






MANAGEMENT OF PREGNANCY. 



45 



garments constitute the costume, and these are so con- 
structed as to allow perfect freedom of every part of the 
body. 

A complete costume for summer wear, according to 

this system, would consist in 
the chemilette, — a combined 
chemise and a pair of drawers, 
around the waist of which 
buttons may be fastened, — to 







Fig. 7.— Jenness-Miller 
Chemilette. 




Fig. 8.— Jenness-Miller Divided 
Skirt. 



which the second article of dress, the divided skirt, or 
Turkish leglette, is buttoned. The latter is made so full 
that it takes the place of petticoats, and the dress may be 
comfortably worn over it. Should the dress be of some 



4 6 



OBSTETRIC NURSING. 



very sheer material, one additional muslin petticoat may 
be worn, similarly fastened to the waist of the chemilette. 
If a person is accustomed to wearing merino or silk un- 
derwear both summer and winter, the jersey-fitting union 
undergarment may be worn beneath the chemilette, 





Fig. 9. — Union Under- 
garment. 



Fig. 10.— Jenness-Miller 
Leglette. 



or, the latter being dispensed with, the Jenness-Miller 
" model bodice," or the Equipoise waist and divided 
skirt may be worn alone over the union undergarment. 
The Delsarte waist has a similar object in meeting the 
hygienic and artistic requirements of woman's dress. 
The elastic lacers used for fastening the latter probably 



MANAGEMENT OF PREGNANCY. 47 

allow the patient to exercise more fully her own discre- 
tion as to the amount of compression of the chest and 
waist thus brought about than is permitted by the more 
unyielding material of the Equipoise waist, hence 
hygienic requirements are probably better met by the 
latter. 

For winter wear, plain leglettes of flannel, cashmere, 
or silk, or the same material as the dress, may be worn 
over the union undergarment and directly beneath the 
dress. Thus underskirts are entirely dispensed with 
and all the clothing is supported from the shoulders. 

The skirts of winter dresses, being comparatively 
heavy, should be fastened to a waist of their own which 
has comfortably cut armholes. 

Garters fastened to the waist are discountenanced, ac- 
cording to this system — as they should be, for they pro- 
duce too much dragging on the waist, and the spiral- 
spring Duplex Ventilated garter is recommended to be 
worn until something better is devised, or safety pins 
may be used to fasten the tops of the stockings to the 
drawers of the union undergarment or buttons and 
button-holes may be similarly used. 

It is probable that the fashion will come into vogue of 
combining the stockings with the union undergarment, 
when garters will be done away with entirely. 

It is well for the stockings to be of wool or silk. 

The shoes or slippers worn should be comfortable and 
with broad soles and low heels. 

Slender women can well wear the chemilettes, dis- 



4 8 



OBSTETRIC NURSING. 



< jT V»«|V3g W»2> 



pensing with all boned waists. Stout women, having 
busts, find more comfortable the model bodice, or the 
Equipoise waist,* which, I believe, is not one of the gar- 
ments of this system, but an exceedingly comfortable 

one, in my opinion. The Del- 
sarte breast support recently 
devised is a form of breast sup- 
port which aims to support the 
weight of the breasts from the 
shoulders, so that waists con- 
taining bones may not be re- 
garded as a necessity, even by 
the stout. Both the " model 
bodice" and Equipoise waist 
(the latter of which I prefer) 
contain bones, but dispense with 
the front steels, so injurious in the ordinary corset. 

For the changes in shape induced by advanced preg- 
nancy the union undergarments will need to be of 
larger size than those ordinarily worn (about two sizes 
larger). Many beautiful designs for dresses and other 
outer garments have been devised by Mrs. Miller, pat- 
terns for which may be obtained of the Jenness-Miller 
Co., in New York, or its agencies in other cities. Before 
leaving the subject I would mention, as one especially 




Fig. ii. — The Equipoise 
Waist. 



* This, with the other garments mentioned, may be obtained through 
the Dress Reform Emporiums in Philadelphia, or similar agencies in other 
cities. 



MANAGEMENT OF PREGNANCY. 49 

praiseworthy feature of this system, the perfect use of 
the arms permitted by the ingeniously devised patterns' 
for sleeves and should'er straps. If the skirts are not 
fastened to a properly constructed waist, as described, 
they should be supported by suspenders. 

When the abdominal walls are much relaxed from 
stretching, allowing the womb to fall forward, it is well 
to use an abdominal binder or belt, especially during the 
last month of pregnancy. This helps to keep the uterus 
in proper position. 

Flannel should be worn — at least during pregnancy — 
both summer and winter. A lighter flannel can be sub- 
stituted in summer for that which would be worn in 
winter. The use of flannel is to prevent chilling of the 
surface, and this is especially important where — as in 
pregnancy — the kidneys are overworked. It is im- 
portant also for the condition of the heart and lungs. 
Coughs often cause premature labors. The jersey-fitting 
knit union undergarment, before referred to, may be 
obtained in all grades and sizes, and is well suited to the 
purpose. 

Bathing is very necessary for a patient during her 
pregnancy, as at other times. As regards the character 
of the bath, she can do as she has been accustomed to, 
using warm or cold water. A change from warm to 
cold water, or vice versa, is, however, not allowable. A 
sponge-bath, followed by brisk rubbing, is the most 
desirable. The skin is thus kept in good condition. 
Shower-baths should be avoided. 
4 



50 OBSTETRIC NURSING. 

Sea Voyages are injurious, because of the danger of 
receiving falls or blows in consequence of the motion of 
the vessel, and also because of the liability to sea- 
sickness induced by them. When it is absolutely neces- 
sary to take a sea voyage, there is probably least danger 
in the last three months of pregnancy, because the pla- 
centa, or afterbirth, is then well developed and its 
attachment to the uterus close. 

The Regulation of the Diet during pregnancy is of 
great importance. A patient should eat heartily for 
breakfast and dinner, but the evening meal should be 
light, especially from the seventh month on to the close 
of pregnancy. This meal should consist of stale bread, 
with butter and cooked fruit, as stewed apples, and a 
glass of milk or weak tea. Digestion is less active in 
the latter part of the day, and often a hearty meal may 
prove the direct exciting cause of convulsions. The 
food should be plain, wholesome, nourishing, well- 
cooked, and chosen in each case with special reference 
to the avoidance of digestive disturbances and constipa- 
tion. Meat in moderate quantity, broths, milk, eggs, 
and fresh fruit should constitute an important part of 
the dietary. Pastry and confections should be avoided. 

There is a mistaken theory prevalent in this day that 
a mother, by abstaining from certain kinds of food, as 
meat, eggs, milk, etc., and confining herself chiefly to a 
fruit diet, may thus, by preventing the hardening of the 
bones of the child, do away largely with the pains of 
labor. The truth of the matter is this : that during 



MANAGEMENT OF PREGNANCY. 5 I 

pregnancy all the functions of the mother's body are 
especially active in promoting the development of the 
child, hence an insufficient supply of essentially nourish- 
ing food will first affect the mother's system and render 
her unfit for the demands upon her strength at the time 
of parturition. 

Should a restriction to the fruit diet effect what it is 
claimed to do as regards the infant, it would result in the 
production of sickly, rachitic children, poorly developed 
mentally and physically. 

Moderate Exercise is essential during pregnancy. 
Walking on a level, not riding, is the best form of exer- 
cise. A daily walk should be taken, not, however, after 
nightfall. The patient should avoid lifting, — in fact, all 
straining movements, — and most particularly should she 
avoid the use of the sewing-machine. Exercise, judi- 
ciously taken by the pregnant woman, serves to prevent 
undue development in the size of the child, and in this 
way serves to make her labor easier. 

Maternal Emotions. — There is sufficient proof that 
the mother's emotions influence the child to render it 
important that her surroundings during pregnancy 
should be as pleasant as possible, and that she should 
avoid fright or any violent emotion. At the same time 
there is no ground for the popular belief that when a 
pregnant woman is thus frightened her child will be 
" marked." 

Complications of Pregnancy. — Chorea, or St. Vitus' 
Dance, Epilepsy, and Insanity are forms of nervous dis- 



52 OBSTETRIC NURSING. 

orders which sometimes complicate pregnancy. Such 
cases require skilled medical treatment. 

Patients with heart trouble, and those who are con- 
suntptive, also require constant medical supervision, as 
pregnancy has a deleterious influence upon them. Con- 
sumptives sometimes feel better while pregnant, but sink 
rapidly afterward. 

Those diseases which are associated with high tempe- 
rature, such as the eruptive fevers and inflammation of 
the lungs, have a marked tendency to bring on the labor 
before time. There is also danger of their inducing 
puerperal septicemia. 

Syphilis is a constitutional disease and a form of 
blood-poisoning which also has an injurious effect upon 
pregnancy. If the pregnancy does not terminate 
prematurely, the child is usually born with the taint of 
the disease. 



CHAPTER IV. 
ACCIDENTS OF PREGNANCY. 

A Discharge of Blood from the womb, known as 
" uterine hemorrhage/' may occur at anytime during the 
pregnancy, and is usually a sign that the patient is threat- 
ened with a miscarriage. However slight the flow, the 
nurse should have the patient lie down until the doctor 
has been told of its occurrence, and decides what the 
patient should do. A note should be sent to the doctor, 
telling just what has happened, and clearly making him 
understand the urgency of the symptoms — that is, the 
amount and character of the flow — and the condition of 
the patient. A nurse should not trust to a verbal mes- 
sage, as the physician may fail to respond to the call 
promptly, not being aware of the urgency of the symp- 
toms. The patient should be required to use the bed- 
pan, or, at least, a vessel the contents of which can be 
thoroughly examined, both for the bowels and the pas- 
sage of urine. All discharges, soiled clothing, clots, 
etc., should be carefully saved for the inspection of the 
physician. 

Meantime, an effort should be made on the part of the 
nurse to control the flow. The patient should lie with 

53 



54 OBSTETRIC NURSING. 

her head low, and a pillow under her hips; she should 
not be warmly covered, plenty of cool, fresh air should 
be admitted into the room, and she should be kept ex- 
ceedingly quiet. 

Should the symptoms become more urgent, the patient 
being threatened with fainting, the head may be lowered 
by raising the foot of the bed, placing bricks or chairs 
under it in such a way as to make a decided inclined 
plane of the bed. The patient should be fanned, given 
hartshorne to inhale, and her limbs rubbed, to keep 
them warm, with alcohol or whisky. Small doses of 
whisky or aromatic spirits of ammonia may be given 
her in cold water, if able to swallow, or black coffee or 
tea, not too warm. If there is much blood flowing from 
the vulva, vaginal injections of hot water, at a tempera- 
ture of about no° to 1 1 5°, may be kept up until the 
flow ceases. The physician when called may think 
it best to tamponade the vagina. For this purpose long 
strips of sterilized gauze or sheeting may be needed, 
which the nurse should have in readiness. 

Alarming hemorrhages are often the result of acci- 
dents, falls, or blows, or they may be caused by heavy 
lifting. 

Hemorrhage from a Low Attachment of the Pla- 
centa, or afterbirth, or when the afterbirth occupies an 
unusual position, — that is, at the side of or over the 
mouth of the womb, — occurs without any history of 
accident. It takes place at any time from the seventh 
month of pregnancy on to its termination, and without 



ACCIDENTS OF PREGNANCY. 55 

any premonitions of its coming. It may occur at night 
while a patient is lying in bed. The management of this 
condition would be the same as that described above, 
until the doctor comes. 

Hemorrhage from Varicose Veins. — Women suf- 
fering from enlarged, swollen veins, " varicose veins," or 
11 varices," of the lower extremities, if not careful in 
keeping the limbs bandaged or supported by elastic 
stockings may have hemorrhage occur by the bursting 
of one of these overdistended veins. The amount of 
blood lost may be so great as to imperil the patient's 
life. Should such a rupture of a vessel occur, compres- 
sion should be made just below the point of rupture, to 
control the bleeding, until the physician, who should 
have been sent for, arrives, when he will resort to the 
measures necessary for securing against further hemor- 
rhage. 

Miscarriages are apt to recur, hence a patient who has 
once suffered from one should be cautioned to take addi- 
tional care of herself during any subsequent pregnancy. 1 
Any sensation of weight about the hips, with the recur- 
rence of a " show," or slight discharge of blood, and 
cramp-like pains should warn her to lie down and send for 
her physician. Such a patient should also take the precau- 
tion to lie down as much as possible (if not in bed, on a 
lounge) during the time when, under other circumstances, 
she would have her monthly flow. Any patient having 
had a number of miscarriages should keep herself under 
the care of her physician from a very early date in the 



$6 OBSTETRIC NURSING. 

pregnancy, being placed under a regular course of treat- 
ment. 

It is well, in this connection, to speak of the impor- 
tance of care in the after-treatment of miscarriages. Not 
uncommonly, patients, especially of the working classes, 
get up and go about their work a day or two after the 
occurrence. This is a dangerous proceeding, for, though 
the ill effects may not be felt for a time, chronic disease 
of the uterus is apt to result. If the pregnancy termi- 
nates before the fourth month it is commonly called an 
abortion. Between the fourth and seventh months it is a 
miscarriage, and after the seventh month, if before term, 
a premature labor. 

It is really necessary to give more time to the recov- 
ery from the effects of an abortion than to recovery from 
a confinement at term, and the patient should be willing 
to remain in bed at least a week or ten days, or longer, 
if thought best by her physician. The patient should 
not leave her bed so long as any discharge of blood 
"continues. 

Premature Rupture of the Membranes enclosing 
the child, with a discharge of colorless liquid,, commonly 
known as " breaking of the waters," is another of the 
accidents of pregnancy, and is invariably followed, within 
a few days, at least, by the expulsion of the child. The 
patient will complain of her clothing becoming wet, 
either by a sudden discharge of a quantity of liquid, or 
by a slow but continuous flow. The nurse can assure 
herself that this liquid is not urine by her sense of smell. 



ACCIDENTS OF PREGNANCY. 57 

The smell of urine is characteristic. With the amniotic 
liquid surrounding the child, there is almost an entire 
absence of smell, a peculiar, faint, musty odor being 
alone recognizable. 

It is best, in removing this wet clothing from the pa- 
tient, to set it away, that the physician may judge for 
himself of the character of the liquid. The patient 
should at once lie down, not taking the erect position 
for any cause, not even for defecation and urination, and 
the physician should be sent for, with a written state- 
ment as to what has occurred. It is important that the 
physician should see the patient as soon after the rupture 
of the membranes as possible, because the sudden loss 
of water may have brought about changes in the position 
of the child which may endanger its life. The loss of 
the entire amount of liquid contained in the sac would 
cause also difficulties in the delivery, or what is known 
as " a dry labor." 

Convulsions may sometimes occur during the preg- 
nancy. The symptoms which threaten this trouble are 
extreme restlessness and uneasiness on the part of the 
patient ; severe headache, often confined to one side of the 
head ; disorders of vision, as seeing things double, or 
seeing but the part of an object, sometimes very imper- 
fect vision, and occasionally absolute loss of sight ; 
twitchings of the muscles, especially of the face, may 
occur. The convulsion is ushered in by this restlessness 
and twitchings, beginning first about the eyes and ex- 
tending rapidly to the mouth, arms, and lower extremi- 



58 OBSTETRIC NURSING. 

ties. The movements are not violent, hence the patient 
is not likely to throw herself out of bed. The physician 
should be sent for; meantime, the nurse should see that 
the patient is kept lying down, that her clothing is well 
loosened, especially about the head and chest, that plenty 
of fresh air enters the room, and that the patient is kept 
from biting her tongue. A folded handkerchief or towel 
slipped in between the teeth pushes back the tongue and 
prevents the teeth from coming down upon it. When 
the physician comes he will probably use an anesthetic 
to relax the spasm, until the system can be gotten 
under the effect of such nerve sedatives as he may direct 
to be administered from time to time. 

The patient's feet should be kept warm and head cool. 
The members of the family must be kept calm and pre- 
vented from meddlesome interference, for the attempt to 
make the patient swallow any stimulant while struggling 
and unconscious may result very disastrously. Should 
the attending physician live too far away or be delayed 
in coming, the nearest physician should be sent for. 



CHAPTER V. 
GERMS AND ANTISEPSIS. 

One of the most important things for an obstetric 
nurse to know is the meaning of the term " antisepsis" 
and the method by which antisepsis may be carried out 
in her work. 

Literally, the term " antisepsis " means u aganist sepsis 
or putrefaction" and refers to the application of means 
by which objects may be rendered entirely free of all 
poisonous elements. 

Dust, as we know, is everywhere present in the atmos- 
phere, and consequently settles upon everything exposed 
td it. This dust consists, as has been found, of very 
minute organisms, which, when they are planted in a 
suitable soil, grow and multiply very rapidly, producing, 
as a result of their activity, the poisonous fluids and 
gases which characterize the process of putrefaction. 

These products are called ptomains. The substances 
thus formed, when absorbed into the blood, give rise to 
the symptoms of blood-poisoning. It may, therefore, 
be plainly seen that the simple neglect of measures to 
destroy these dust germs may, by allowing decomposi- 
tion of the natural discharges, lead to septic poisoning. 

59 



60 OBSTETRIC NURSING. 

It has been found, as a matter of experience, that 
other diseases besides those commonly classed under 
the head of " childbed fever," or " puerperal sepsis," 
may be induced by these small germs, and this explains 
why it is so very important that erysipelas, scarlet fever, 
or other acute contagious diseases should be avoided by 
those engaged in obstetric practice. A nurse leaving 
such a case to go to a confinement case does so at the 
risk of her patient's life, for puerperal fever will almost 
certainly be induced by the germs which she carries 
from the former case. 

Germs. — The minute bodies known as germs are, we 
see, greatly to be dreaded. They are of three kinds : 
first, those to whose action most of the infective diseases 
are attributed, and which are divided, according to their 
shape, into micrococci — round-shaped bodies ; bacteria 
— oval-shaped bodies ; bacilli — rod-shaped bodies of 
varying length; and spirilla, or spiral, thread-like 
bodies ; second, yeasts ; third, molds. 

To give an idea of their size, it has been said of one 
of the most common forms of germs (the rod-like), that 
were fifteen hundred of them put end to end, they 
would scarcely reach across the head of an ordinary pin. 

Their rate of growth, too, is very rapid, a common 
estimate being that they double themselves once or twice 
every hour. Thus, in the course of twenty-four hours a 
solitary germ may become a colony of between sixteen 
and seventeen millions. 

Warmth, moisture, and a certain amount of organic 



GERMS AND ANTISEPSIS. 6l 

matter are the conditions which favor their development. 
Most, but by no means all, forms of bacteria require air; 
some, however, can only develop in the absence of air. 

Germs may grow by division ; that is, one of them 
may have a constriction form about its middle which 
finally becomes a complete partition, so that two distinct 
germs are thus formed. These similarly divide, and 
thus their number multiplies. Another method of 
growth is by spore formation. At one or more points in 
a rod an oval spot appears, which becomes brighter and 
clearer. These spots are spores, and when fully devel- 
oped they become free, the rest of the rod dissolving 
away. These spores retain their vitality for years, ready 
at any moment when suitable conditions are provided to 
develop into fully formed germs. It is extremely diffi- 
cult to destroy the vitality of these spores. Many anti- 
septics which readily kill the adult germs will not harm 
the spores — or only do so after a much longer time than 
is necessary for the adult germ. 

Even where the antiseptics do not kill, however, they 
may retard the development of these germs and thus 
prevent their doing injury. 

In all germ diseases a battle is fought between the 
patient's body and the germs with which it is infected. 
If the germs are present in small quantity only, it is 
possible the resisting power of the body may enable 
them to be overcome. 

If, however, the general health is impaired by over- 
work, deficient food, overcrowding, or other depressing 



62 OBSTETRIC NURSING. 

influences, the patient will be more likely to succumb to 
the attack. This explains why some patients escape 
under the same conditions in which others suffer from 
blood-poisoning. 

Lying-in patients are especially liable to germ infec- 
tion, both because the labor leaves them in a state of 
exhaustion, and because there are always certain open 
surfaces present upon or within such a patient's body — 
so that these serve as direct avenues for the entrance of 
poison into the system. The site within the uterus from 
which the placenta, or after-birth, is detached is one of 
these; others being the fissures or lacerations about the 
neck of the uterus, the vagina, or the perineum. This 
shows the importance of protecting from decomposing 
discharges all such open surfaces. 

Experiment has shown that bruised tissues are espe- 
cially liable to destructive inflammation from the action 
of germs. This explains why first labors and difficult 
and tedious labors are most apt to be followed by septic 
infection. 

Should such a labor be followed bv the occur- 
rence of sloughing wounds, it is especially important 
that any discharges from the wound should not be 
retained, but kept carefully removed by means of anti- 
septic irrigation, etc. Care should be taken that the 
antiseptics used should not be in sufficient strength, 
however, to irritate the wound, as this may increase the 
trouble. 

Any condition, such as an attack of inflammation, 



GERMS AND ANTISEPSIS. 63 

exposure to cold, or disordered digestion, because it 
lowers the vitality of the body, tends to increase the 
tendency to septic infection. 

Besides the diseases resulting from the classes of 
germs most commonly concerned in the production of 
putrefactive changes in the body, we have some which 
are due to "mold-infection" and the action of yeasts — 
which are also lowly organisms existing in great num- 
bers in the atmosphere, and capable of setting up 
destructive changes in tissues. It is the " molds " 
which are the cause of food spoiling when allowed to 
stand exposed to the air. The disease known as 
" thrush," which is characterized by grayish patches 
forming upon the mucous membrane of the mouth and 
adjacent parts, is due to a parasite which is one of the 
"yeasts." A number of skin diseases are caused by the 
growth of " molds." 

Experiments. — In order to prove the fact that animal 
fluids will not undergo putrefaction if germs are excluded 
from them, a series of very interesting experiments were 
made for a class in one of the London hospitals recently, 
to illustrate some of the most common errors in nursing. 
These can be repeated for class instruction anywhere. 

A series of glass tubes were taken, into which some 
sterilized beef-tea or beef-jelly was introduced. Into 
two of these tubes scrapings from under the finger-nails 
were placed, and in one the little specks were soon seen 
to eat their way into the jelly, followed by a trail of 



64 OBSTETRIC NURSING. 

microbes. In the other tube a dense mass of molds 
developed, and the beef-jelly was transformed into a 
dark brown color. 

Into a third tube a piece of cotton used in wiping the 
vulva of a lying-in woman, previous to passing the 
catheter, was dropped, with the result of showing almost 
immediately a mass of germs which descended into the 
jelly, liquefying it by their presence, while the cotton, 
owing to the air it contained, floated on the surface. 

A drop or two of urine from the bladder of a patient 
suffering from inflammation which had resulted from the 
use of an unclean catheter, was introduced into a fourth 
tube containing the sterilized beef-jelly. This caused 
the jelly from above downward to be converted into a 
dirty-looking yellow fluid, while a whitish mass of germs 
accumulated on the surface of the jelly. 

The importance of antiseptic precautions in the nurs- 
ing of infants was well illustrated by two other experi- 
ments. Into a tube containing some of the sterilized 
beef-jelly a drop of sour milk was placed ; very rapidly a 
moldy coating appeared over the surface of the jelly. 
When we think of a similar process taking place in the 
digestive tract of an infant, we can realize why babies 
suffer so greatly from careless management of their 
food. 

Another tube had introduced into it some scrapings 
from the mouth of a child suffering from "thrush." 
Colonies of snowy-white germs appeared which, as they 



GERMS AND ANTISEPSIS. 65 

grew larger, became of a greenish color and spread with 
great rapidity. 

As object-lessons serve to impress the importance of 
facts, these experiments serve to keep before us the 
importance of antiseptic precautions in the care of 
mother and child. 



CHAPTER VI. 

APPLICATION OF ANTISEPSIS IN CONFINEMENT 

NURSING. 

The use of antiseptics has almost entirely annihilated 
puerperal fever, commonly known as " child-bed" fever. 
This disease, as we know, is simply blood-poisoning, or 
septicemia, and is caused by the entrance through a 
wound of some poisonous material into the blood. In 
the simplest and most natural labors slight tears are apt 
to exist either about the external parts or about the 
neck of the uterus. There is always a wound inside of 
the uterus at the place where the placenta or after-birth 
was attached. In difficult labors there may be extensive 
wounds. 

Septicemia, or blood-poisoning, may be caused by a 
piece of placenta or blood-clot being retained in the uterus 
or birth-canal after the delivery, and there putrefying. 
It may also be caused by the patient's attendants having 
some poisonous material on their hands, instruments, 
or various appliances, and bringing these in contact with 
her wounds. Dirty hands, dirty finger-nails, unclean 
bed-pans, soiled clothing, etc., may be the cause of the 
trouble. Sponges should never be used in the lying-in 
room. Artificial sponges made of antiseptic cotton 
enclosed in gauze may be substituted. The poisonous 

66 



ANTISEPSIS IN CONFINEMENT NURSING. 67 

material which might be thus conveyed to the wounds 
of the lying-in woman must be guarded against by the 
most scrupulous attention to thorough cleanliness. 

Antiseptics are chemical substances which have the 
power of destroying the germs of putrefactive change or 
of rendering them inert. They should, therefore, be sys- 
tematically used in all cases of labor to prevent septic 
germs from entering the wounds and giving rise to puer- 
peral fever. The antiseptics most generally employed 
in the maternity wards of the Woman's Hospital are 
lysol, formalin, creolin, carbolic acid, corrosive subli- 
mate, permanganate of potassium, iodoform, chlorinated 
lime, boric acid, salicylic acid, oxalic acid, and tincture 
of iodin, according to the purpose for which each is 
designed. 

Solutions of corrosive sublimate should not be put 
into a metal dish, as the metal is thus corroded. The 
strength of all antiseptics is impaired by admixture with 
soap, so that one should not wash with soap in an anti- 
septic fluid. 

The following rules, indicating the antiseptic precau- 
tions observed in the maternity wards of the Woman's 
Hospital, will illustrate the precautions to be observed 
in all confinement nursing: — 

RULES TO BE OBSERVED BY NURSES.*. 

I. The nurses on duty in the maternity wards shall 
have no communication with the general wards of the 

* Rules for preparation of the patient for labor are given else^Yhere. 



68 OBSTETRIC NURSING. 

Hospital. They shall be transferred to separate dormi- 
tories from those occupied by nurses on duty in the 
general wards. They shall give especial attention to 
personal cleanliness. 

2. They shall not touch the genital organs of a patient 
without having first thoroughly disinfected their hands. 
If their hands have come in contact with any foul dis- 
charges, this cleansing shall be accomplished as follows : 
1st. Thoroughly wash the hands with soap and water, 
scrubbing them well with a clean nail brush. 2d. Wash 
the hands in a saturated solution of permanganate of 
potassium, which colors them brown. 3d. Bleach the 
hands by washing them in a saturated solution of oxalic 
acid. 4th. Rinse them thoroughly clean in boiled, fil- 
tered water. 5th. Dip them for at least two minutes in 
a solution of bichlorid of mercury (corrosive sublimate), 
of the strength of from 1-1000 to 1-4000, or a solution 
of carbolic acid or lysol 2 per cent. The washing with 
permanganate of potassium and oxalic acid solution 
may be omitted where foul discharges have not been 
handled. 

3. Bottles containing solutions of corrosive sublimate 
1- 1000, and carbolic acid 1-40, shall be placed on the 
washstand in every ward and delivery room. The solu- 
tions of permanganate of potassium and oxalic acid shall 
be kept ready for use in the bath-rooms. A small jar 
of lysol, to be used in 2 per cent, solution when a lubri- 
cant is needed, shall be kept in each room. 

4. The dressings removed from a patient shall at once 
be carried out of the room and burned in the furnace. 



ANTISEPSIS IN CONFINEMENT NURSING. 69 

5. Immediately before the application of a fresh dress- 
ing the nurse shall irrigate the external genitalia with 
either a corrosive sublimate solution 1-4000 or carbolic 
acid 1-40, dry the parts with a piece of antiseptic lint, 
and then apply the antiseptic dressing. (Directions for 
preparation of antiseptic dressings are given elsewhere.) 

6. If the patient be a primipara (a patient with her 
first child), an iodoform suppository (15-30 grs.) shall 
be introduced into the vagina for a week, once daily, 
unless directed otherwise. 

7. Metal and glass catheters shall be cleansed after 
each use by boiling, and kept in the intervals of use in 
a solution of carbolic acid 1-40, or lysol, two per cent. 

Vaginal nozzles shall be similarly treated. Each 
patient shall have a separate vaginal nozzle for her 
exclusive use. 

Soft rubber catheters, after a thorough cleansing with 
soap and water, shall be kept in a solution of corrosive 
sublimate 1-1000, or a carbolic acid or lysol solution as 
above. 

Before using the catheter the nurse shall wash it off 
with sterilized water and dip it into a lysol solution of 
1 per cent. 

8. Syringes shall be cleansed after each use by hav- 
ing an antiseptic solution pumped through them. No 
vaginal injections shall be given during the lying-in> 
except after a direct order from the physician. 

9. If vaginal injections are required to be given when 
there is much fetid discharge from the vagina, an injec- 



JO OBSTETRIC NURSING. 

tion of lysol solution, y 2 to i per cent., or perman- 
ganate of potassium (a sat. solution) may be given in 
preference to the ordinary solution of 1-4000 corrosive 
sublimate or 1-40 carbolic acid. The nurse should 
always carefully report the occurrence of any odor in 
the discharge. 

10. All rubber sheets used about the patients' beds 
shall be washed in a solution of corrosive sublimate 
1-1000 or carbolic acid 1-20. 

11. All clothing removed from patients or their beds, 
soiled with discharges, shall be at once taken to the 
soak-tubs at the wash-house. When the blood has 
been soaked out in cold water they shall be placed in a 
disinfectant solution of carbolic acid 1-20 for an hour, 
and then put through the ordinary processes of the 
wash, being thoroughly boiled. 

All soiled clothing shall be at once removed from 
patients' rooms. 

12. On the death of any patient in the maternity the 
body shall be at once wrapped in a bichlorid sheet 
(1-1000) and removed to the mortuary. 

13. No one shall be allowed to visit the Hospital 
who is engaged in the dissecting rooms, or attending 
postmortem examinations, or doing work in operative 
surgery upon the cadaver. No one attending infectious 
cases shall be admitted to the lying-in wards. 

No visitors shall be admitted to see patients in the 
maternity unless provided with a special pass from the 
physician in charge. 



ANTISEPSIS IN CONFINEMENT NURSING. /I 

14. Each room vacated by a patient shall be thor- 
oughly cleaned and, if necessary, fumigated before it is 
again occupied. 

The straw contained in the mattress upon which she 
lay shall be burned and the ticking boiled and then 
refilled with fresh straw for the next case. Should 
other than straw mattresses be used, they will require 
disinfection by dry or steam heat in a sterilizer especially 
constructed for the purpose, or may be subjected to the 
disinfecting fumes of formaldehyd gas. 

The bed, stands, etc., shall be wiped off with a solution 
of corrosive sublimate or carbolic acid when the room is 
reopened after fumigation, or maybe sprayed with vapor 
of formaldehyd. 

15. The mother's nipple and the baby's mouth shall 
be washed with a solution of boric acid (10-15 grs.) to 
the ounce) before and after each nursing. 

16. The baby's cord shall be kept dressed with sterile 
gauze, which shall be changed as often as necessary. 

17. Immediately after delivery the baby's eyes shall be 
washed with a saturated solution of boric acid or one of 
nitrate of silver (1 gr. to the ounce) as directed. 

Symptoms of Infection. — Every nurse should know 
how to watch for symptoms which may indicate that 
there is an undue absorption of the antiseptic employed 
taking place. 

As to the selection of the antiseptic employed, the 
choice will be dependent upon the physician. If the 
nurse is obliged to depend upon herself, certain points 



72 OBSTETRIC NURSING. 

must be taken into consideration. Thus, she must 
remember that patients with kidney disease are especi- 
ally susceptible to poisoning from the effect of corrosive 
sublimate; anemic or bloodless patients bear both car- 
bolic acid and corrosive sublimate badly; children are 
particularly susceptible to carbolic acid. 

Poisoning from Antiseptic Agents in confinement 
nursing most frequently occurs from the use of the 
antiseptic agent in the vaginal douche. 

It is not unusual, when carbolic acid has been em- 
ployed for some time, to find the urine of a dark greenish 
color; also to find that it contains albumin. One or 
more of the following symptoms may also be present : 
sickness or nausea, increased flow of saliva, difficulty in 
breathing, an anxious expression, sometimes fever, and 
always great weakness. 

Should any of these symptoms arise, the doctor should 
be at once notified. The patient may be stimulated by 
repeated small doses of brandy, and external friction 
should be employed. 

If carbolic acid has been swallowed, the first thing to 
do is to get rid^of the poison by the administration of an 
emetic, as by copious draughts of mustard and water or 
salt and water; or the stomach should be washed out 
with the stomach pump. The easiest and one of the 
best things to use after this would be sweet oil or cotton- 
seed oil in large quantities. The patient's body must 
be kept very warm by hot blankets, and rectal enemata 
of beef-tea or milk and whiskey used. 



ANTISEPSIS IN CONFINEMENT NURSING. 73 

The mouth and bowels are most apt to be first affected 
by the absorption of corrosive sublimate. Any tender- 
ness or sponginess of the gums must be noticed, or in- 
crease in the amount of saliva. Looseness of the bowels 
also requires the immediate discontinuance of the drug. 
Headache, dizziness, pains in the abdomen, lowering of 
temperature, sweats, and general prostration, with albu- 
minous and sometimes bloody urine, are other symptoms 
which may arise from the same cause. 

The drug must be stopped at once, the abdominal 
pain relieved by the use of poultices, a soothing diet of 
rice-milk or arrow-root, etc., employed, and such medi- 
cines given as the doctor may direct. 

If the drug is swallowed by mistake, the same treat- 
ment would have to be followed as in the case of carbolic 
acid poisoning, except that it is best at once to admin- 
ister the whites of two or three eggs to form an insoluble 
albuminate of mercury in the stomach, so that it may 
not be readily absorbed, but brought up by the use of a 
subsequent emetic. 

In mild cases, sleeplessness, headache, loss of memory, 
are the main symptoms, but in severe cases mania, mel- 
ancholia, or hallucinations may develop from iodoform 
poisoning. Sometimes there is considerable rise in tem- 
perature. The withdrawal of the drug and the support 
of the patient's strength constitute the main line of treat- 
ment. Sometimes the use of about ten grains of cream 
of tartar, every hour for a time, has been found of 
advantage. 



74 OBSTETRIC NURSING. 

Lysol, creolin, permanganate of potassium, boric acid, 
and salicylic acid are harmless, so far as toxic effects are 
concerned, but have not the same power. 

Chlorid of lime and chlorinated soda are of value as 
antiseptics because of the chlorine which is set free in 
their solutions. A small quantity, as from a half to one 
dram of the powdered chlorid of lime, may be dissolved 
in a pint or more of water. 

The chlorinated soda is found in a preparation known 
as Labarraque's solution, of which a tablespoonful to a 
pint of water makes a solution strong enough for a, 
vaginal injection. If to each ounce of this solution 
about four grains of permanganate of potash are added, 
the value of the solution as an antiseptic agent is greatly 
increased. 

Condy's fluid contains, as its active ingredient, per- 
manganate of potash, about eight grains to the ounce of 
water. A teaspoonful of Condy's fluid to the pint of 
water makes a solution suitable for a vaginal injection. 

It is not likely that poisoning would occur from the 
use of any of these agents. 

Permanganate of potassium and . Condy's fluid are 
objectionable because of the brown stain they produce 
when dropped on clothing. 

Lysol is a coal-tar product now largely used as a dis- 
infectant in several surgical and lying-in clinics in Ger- 
many. It is claimed to be superior to carbolic acid, 
creolin, and other preparations of the same kind in its 
germicidal action, and it possesses powerful deodorizing 



ANTISEPSIS IN CONFINEMENT NURSING. 75 

properties. It is perfectly soluble in water, and its solu- 
tions are soapy in character, removing all dirt (fatty or 
resinous spots, etc.), which does away with the necessity 
for soap in cleansing. It is used in one-half, one, and 
two per cent, solutions in midwifery and surgery. 

Formalin is a forty per cent, solution of pure formal- 
dehyd gas in water, to be further diluted with water for 
the purpose for which it is required. It is a powerful 
disinfectant for rooms, furniture, clothes, and the person. 
It is said to have the same germicidal power as corrosive 
sublimate without its toxicity. It is' used in one-half to 
one per cent, solutions as awash for internal cavities ; in 
two per cent, solution as an application to the skin. 

Rooms are disinfected, particularly after cases of 
septicemia, as follows: Burning sulphur may be used 
in the proportion of at least three pounds for every 
thousand cubic feet of air space. To secure any good 
results, the apartment should be made as close as pos- 
sible by stopping up all apertures, through which the 
gas might escape, by means of wet rags, which may be 
stuffed into the cracks around doors, windows, etc. The 
sulphur is put into a deep tin pan, which is placed upon 
two bricks, in a tub partly filled with water, in the mid- 
dle of the room. A little alcohol may be poured on the 
sulphur, which is then set on fire, or a few live coals 
placed in the pan. The fumes should be kept in the 
apartment from twelve to twenty- four hours, after which 
doors and windows should be thrown open, and it should 



j6 OBSTETRIC NURSING. 

be subjected to free ventilation. All surfaces in the 
room must then be washed off with a carbolic acid solu- 
tion (two per cent.), or corrosive sublimate i-iooo. 

The generation of formaldehyd gas in definite quan- 
tities for the disinfection of houses, rooms, furniture, 
bedding, and clothing is a later approved method of 
procedure, and has received the indorsement of Medi- 
cal Health Officers both here and abroad. 

Different forms of apparatus have been devised for 
generating formaldehyd gas. For practical house- 
disinfection the gas generated from 8 ounces of a 40 
per cent, solution of formaldehyd, to which has been 
added 10 per cent, of glycerin, is required for every 
1000 cubic feet of space. 

Two forms of apparatus are offered for the purpose — 
the Formalin Disinfector, for the disinfection of large 
rooms or entire buildings, and the Formalin Disinfectant 
and Deodorizing Lamp. 

Whatever make of apparatus is employed, it is essen- 
tial that the formaldehyd vapors generated shall be in 
real gaseous form and in a superheated state. Formalin 
pastilles, each containing 15.4 grains, may be used to 
generate the gas. Two pastilles (30.8 grains) are re- 
quired for each cubic meter (35 cubic feet) of air space. 
Directions for using the different forms of apparatus 
are supplied by their manufacturers, as also for the 
means to be employed for generating the gas. Formalin 
vapor is innocuous to the higher animals and to man, 



ANTISEPSIS IN CONFINEMENT NURSING. JJ 

and is said not to injure the most delicate fabrics. Its 
advantage in this respect over sulphur fumigation may 
readily be seen. 

Evolved in the proportions above mentioned, it is said 
to destroy the bacilli of typhus, diphtheria, and all the 
ordinary infectious diseases. 

All the windows and doors in the room to be disin- 
fected should be closed, also all large openings, as 
radiators, chimneys, etc. The closing of very small 
cracks and openings is unnecessary, as the formaldehyd 
gas is heavy and does not easily escape from the room. 
Articles in the room, as linen, quilts, blankets, etc., 
should be stretched out on a line, in order that as much 
as possible of their surface shall be exposed to the 
action of the fumes. Books should be suspended by 
their covers, so that the pages are open and fully ex- 
posed. 

The gas is introduced into the closed room through 
the keyhole of the door, into which the outlet tube from 
the generator is carried. 

The accompanying illustration shows the method of 
employing a formaldehyd gas generator. 

The stout copper retort has a capacity of four pints. 
The aperture at the top is closed by a stopper, held in 
position by a thumb-screw and yoke, " B." Two brass 
tubes enter the stopper ; the inclined or outlet tube is 
connected by a short length of flexible rubber tubing 
with a smaller brass tube, which is introduced through 
the keyhole of the room to be disinfected. 



78 



OBSTETRIC NURSING. 



The second tube entering the stopper extends to y 1 ^ of 
an inch of the bottom of the retort, and serves as a level 
indicator to indicate when the solution has nearly all 




Fig. 12. 



evaporated by liberation of vapor. It is provided with 
a copper funnel for refilling without stopping the opera- 
tion. This tube can be closed by means of the stop- 
cock, " A," and is merely opened for a few seconds 



ANTISEPSIS IN CONFINEMENT NURSING. 79 

toward the end of the operation to ascertain whether 
the retort is nearly empty, as the gas will then escape 
through the orifice of the stop-cock. 

The apparatus is heated by means of a special Primus 
blast lamp, burning kerosene oil, which requires no wick. 
It requires no attention after lighting, excepting about 
once every hour, when it requires pumping for a few 
seconds by the piston/' G." The lamp can be instantly 
extinguished by one turn of the thumb-screw " F." It 
will burn several hours with one filling. 

The retort is placed in a ring which is firmly braced 
in position by four brass supports or bands. It can be 
removed by the turn of a screw at " C." The lamp is also 
detachable from the supports. The whole apparatus is 
firmly braced together, and can easily be carried by the 
handle when filled for use. The gas generated needs to 
be left in the room at least three hours. 

Infected Underclothing, Bedding, etc., are best 
destroyed by fire, if of little value. To disinfect them 
we may employ — 

(a) Disinfection by formaldehyd fumes or vapor. 

(b) Boiling for at least a half hour. 

(c) Immersion in corrosive sublimate solution 1-1000 
for three or four hours. 

(d) Immersion in a 5 per cent, carbolic acid solution 
for three or four hours. 

To avoid the discoloring effects of these solutions, 
clothing taken from them should be thoroughly rinsed 
out in clear water before it is sent to the laundry. 



80 OBSTETRIC NURSING. 

Outer garments which would be injured by boiling 
water or a disinfecting solution mav be sterilized — 

(a) By formaldehyd disinfection. 

(b) By exposure to dry heat at a temperature of 230 
F. (uo° C). 

(J?) By the steaming process in a suitable apparatus, 
such as is found in most hospitals. Clothing which can 
not be thus thoroughly disinfected must be burned. 

Mattresses and Blankets should be disinfected in the 
same way. If these means are not available, mattresses 
may have their coverings removed, and washed and 
boiled separately, the contents being immersed in boil- 
ing water for a half hour. 

Water-closets. — Solutions of copperas (sulphate of 
iron) or green vitriol, in the proportion^of \y 2 pounds 
to a gallon of water, are good, and also very cheap, for 
disinfection of water-closets, etc. The corrosive action 
of copperas on wood must be borne in mind in its use, 
and solutions employed not allowed to drip on the wood- 
work in the room. 

Slaked lime and chlorid of lime may be used for 
privy vaults. 

Solutions of the chlorid of lime may also be used in 
water-closets, but there is danger of choking up the 
pipes if the solutions contain considerable deposit. Car- 
bolic acid solutions, 5 per cent, or bichlorid 1-1000, may 
be used instead of the above. 



CHAPTER VII. 
PREPARATIONS FOR THE LABOR. 

The relations between nurse and patient begin from 
the time the engagement is made for a nurse's attendance 
upon the confinement. 

The nurse is generally consulted beforehand as to the 
articles that will be needed at the time of the confine- 
ment and for the baby's outfit. Also, she is sometimes 
asked concerning the choice of a room for the labor and 
lying-in. 

The room is a most important consideration. It 
should be light, having the free entrance of sunlight, 
quiet, and well ventilated. It should not be too near a 
water-closet ; in fact, it is far better to have the water- 
closet out of the house entirely. There should be no 
stationary washstand in the confinement room ; or, if 
this cannot be avoided, the connection with the sewer 
pipe should be cut off, or the holes and escape pipe in 
the basin plugged up, the basin being kept filled with 
fresh water frequently changed. No slop jar or any 
vessel containing wash water, discharges, etc., should be 
allowed in the room. An ounce of prevention, in the 
way of keeping disease germs out of the room, is worth 
more than a pound of cure. 
6 81 



82 OBSTETRIC NURSING. 

As regards the mother's dress, she should be advised 
to have a sufficient number of good-sized merino or 
flannel vests, to be able to change night and morning, 
so that the same vest shall not be worn both day and 
night. These are more readily changed if opened all 
the way down the front and fastened with tapes. The 
free action of the skin after delivery necessitates the use 
of flannel or merino to prevent chilling. If a long night- 
dress is worn, there is no necessity for the chemise. 
The night-dress, also, should be opened all the way 
down the front, as it renders easier for the patient* the 
frequent changes which are necessary. Sufficient night- 
dresses and vests should be provided to make it possible 
for the clothing to be changed every day. 

Two or three abdominal bandages, also, should be pro- 
vided, either fitted to the patient's person or straight. If 
fitted, the bandages should be prepared when the patient 
is about six months pregnant^ to be the right size after 
delivery. The bandages should extend from the pubic 
bone (the bone just above the external generative organs) 
to the breast bone, being about a half-yard wide and 
long enough to go once around the body and overlap one- 
third. It is best made of soft muslin doubled, the seams 
being turned in at the edges. Large safety-pins should 
be provided for fastening this bandage down the front. 

Where the breasts are large and pendulous, some 
bandage may be required for their support. An abdom- 
inal bandage may be used for this purpose, though it is 
rather wider than is necessary. 



PREPARATIONS FOR THE LABOR. 



83 



When the physician does not require the antiseptic 
dressings, now almost universally used, at least two 
dozen napkins of diaper linen should be provided for the 
mother, as very frequent changes of the napkin are 
essential during the first few days after the delivery, 
while the discharges are free. The napkins should be 
baked before they are used. 

The antiseptic dressings used in the Woman's Hospital 
of Philadelphia consist of sterilized gauze and gauze and 




Fig. 13.— Occlusion Dressing.— {Dr. Garrigues.) 



cotton pads. A number of these dressings being pre- 
pared may be folded in a towel and placed in a steam 
sterilizing apparatus or baked in an ordinary oven for 
an hour. When removed they should be kept enclosed 
in the towel without opening until required for use. 
The Garrigues occlusion dressing, employed in many 
large lying-in hospitals, is shown in the accompanying 
cut. It consists of a piece of dry patent lint, 6X8 
inches, which has previously been rendered antiseptic 



84 OBSTETRIC NURSING. 

by saturation in a solution of bichlorid of mercury i-iooo. 
This is placed, doubled in its width, so as to make a 
dressing, 3X8 inches, directly over the external organs 
of generation. This lint is covered by a piece of gutta- 
percha tissue, 4X9 inches, which is wet in a 1-4000 
solution of bichlorid of mercury. 

These dressings are kept in place by a napkin of sub- 
limated cheese cloth, 18 inches square, folded to form a 
diagonal 5 inches in width, within whose folds a pad of 
sterilized oakum or cotton waste is enclosed. The 
napkin is tightly fastened to the abdominal bandage, 
both anteriorly and posteriorly, by means of safety-pins, 
and the access of air to the vagina is thus prevented. 
These dressings are changed at least once in three hours, 
the dressing removed being at once burned. It is seldom 
necessary to continue the dressings longer than two 
weeks. They should be kept up, however, so long as 
the discharge persists. 

After the above statement, it will be seen that a nurse 
should have the patient obtain of each of the articles 
comprising the dressing the following quantity : Cheese 
cloth, 12 yards; gutta-percha tissue, I yard; patent lint, 
2 yards ; oakum or cotton waste, ^ to I pound. 

The cheese cloth may be obtained at any dry-goods 
store, and prepared by first thoroughly washing with 
soft-soap and boiling, and then wringing it out in a solu- 
tion of bichlorid of mercury 1-1000. The patent lint 
should be rendered antiseptic in the same way. The 
sterilized gauze or lint may then be rolled in a baked 



PREPARATIONS FOR THE LABOR. 



85 



towel and dried in an oven. The gutta-percha tissue, 
patent lint, and oakum may be obtained at a drugstore; 
the gutta-percha tissue may be more readily obtained 
directly from a rubber store, where the syringe also may 
be bought. 

In winter it is well for the mother to be provided with 
a " Nightingale wrap!' This is made of two yards of 





Fig. 14. — Nightingale Wrap. 




flannel of ordinary width. A straight slit, six inches 
deep, is cut in the middle of one side, the points so 
formed being turned back to form a collar. The corners 
farthest from this collar are also turned back to form 
cuffs. The whole may be bound or pinked around the 
edge and fastened by means of buttons or ribbons. 
For the confinement bed the patient should provide 



86 OBSTETRIC NURSING. 

two pieces of rubber-cloth a yard and a half square. 
For a single bed two rubber army blankets maybe used, 
if, as in the maternity practice in the Woman's Hospital, 
it is desired to cover the whole bed. The arrangement 
of the bed will be explained in a later chapter. White 
rubber gum-cloth is the best when it is obtained in the 
piece. If the patient is poor, table oil-cloth may be 
used ; it is cheaper and answers the purpose as well ; or 
layers of newspapers tacked together will make very 
good temporary pads. 

A piece of floor oil-cloth is the best protection for the 
carpet at the side of the bed. 

Rubber-cloth should never be used but for one con- 
finement. The rubber cracks when folded and put away, 
and no longer serves its purpose of protecting the bed. 
Then, too, it is very important to be sure that everything 
about the confinement bed is perfectly fresh and clean. 
Hence a rubber-cloth used for confinement should neither 
be borrowed nor lent. 

Sleeping on rubber-cloth makes a person perspire, 
hence it is desirable to get rid of it as soon as one can. 
It is seldom necessary to use it after the fifth or sixth 
day. 

Other articles necessary to have on hand will be half 
a dozen old sheets, about a dozen towels, a new syringe 
(a fountain syringe, large size, is the best), a bed-pan 
(French pattern), nail-brush, white Castile soap, ajar of 
cosmolin or vaselin. 

I desire, in this connection, to emphasize the fact that 



PREPARATIONS FOR THE LABOR. 87 

the syringe should be a new one. This is an antiseptic 
precaution. Hence advise the patient strongly against 
the use of any syringe which may have been used for 
other purposes, however well it may work. Of course, 
the borrowing of such an article from a neighbor or 
friend should be strongly discountenanced. 

Regarding the baby's clothes, if they are made too elab- 
orate they will not be washed often enough, hence they 
should be plain. As the depressing influences of cold 
are very injurious to babies, the clothing should be warm, 
hence a flannel garment with long sleeves and high neck 
should be worn next the skin, the thickness varying 
with the season of the year. The activity of the life 
processes make it important that every organ of the 
body should be unimpeded in its action and free from 
pressure, hence the clothes should be very loose and light 
in weight. 

The only articles absolutely needed to constitute an 
outfit are, 1st, a soft flannel shirt, with high neck and 
long sleeves, opened in front. This is better than the 
merino vests or the knit shirts, which shrink on washing, 
and are then difficult to put on and take off. 2d. A binder, 
or bandage of fine, soft flannel, four inches wide, and 
long enough to go around the abdomen once and lap 
over about one-third. This should be made without a 
hem, the raw edge being overstitched to prevent ravel- 
ing. The binder is best fastened by means of two pieces 
of tape attached to one of its edges. 

This arrangement does away with the necessity for 



88 OBSTETRIC NURSING. 

pins in fastening the binder, the pieces of tape being 
simply wound around the body to secure the binder, 
and tucked in at one edge. Some prefer the knitted 
wool band, made of single zephyr and knitted in the 
ribbed stitch, as wristlets or mittens are often knit, to 
permit of greater elasticity. These bands are made a 
little narrower in the center than at either extremity, so 
as to be held in place better. They are made perfectly 
circular, just like a wristlet, and are so elastic that they 
can readily be drawn up over the limbs and adjusted 
to the body. 3d. A napkin of cotton or linen diaper is 
the best ; Canton flannel makes a very poor baby's nap- 
kin, as it becomes stiff when washed. Napkins are gen- 
erally made too large for a new-born baby, and require 
to be folded into too many thicknesses. A napkin which 
when folded once is half a yard square, is of ample size. 
The number of napkins supplied should be generous, so 
as to permit of frequent washing and thorough airing. 
Napkins should always be fastened by safety-pins. For 
the protection of the outer garments from dampness due 
to frequent urination, it is well to have a second napkin 
folded and laid beneath the baby's hips. The use of 
rubber-cloth over the napkin for this purpose is much 
to be condemned, as it overheats the parts and makes 
the skin tender. 4th. A flannel slip of heavier or lighter 
texture, according to the season, serves the purpose both 
of petticoat and dress. This should be made just long 
enough to cover the baby's feet — about twenty-five 
inches from neck to hem, and should be fastened in front. 



PREPARATIONS FOR THE LABOR. 89 

The ordinary fashion of making a baby's clothes very 
long is objectionable because of the greater weight of the 
clothes preventing free movement of the child's limbs 
and the development of its muscles. The object of 
fastening the clothing in front rather than in the back 
is to avoid the necessity of the baby's lying on the un- 
even surfaces produced by buttons, tapes, and hems, 
which no doubt are often a source of discomfort to its 
tender skin. 5th. Knit woolen socks are necessary to 
keep the baby's feet warm, and it is well to have them 
extend pretty well up the leg, reaching even to the knee, 
as cold feet are often an exciting cause of colic. 

The above are the only essential articles of clothing 
for a baby. Should the mother prefer, for the sake of 
effect, to see her baby in white muslin, a slip of muslin 
can be worn over the flannel slip. These garments do 
away with all waistbands and the constriction of the chest 
thereby induced. Should the garments be made with 
waistbands, they should be supported from the shoulders 
by means of straps, or armholes should be made in the 
bands, just as in the case of an older child; they will 
not need then to be drawn so tightly around the child 
to be retained in place. 

A heavy blanket is not needed to wrap the baby in, 
in a room at the temperature of the lying-in room — from 
68°to 70 ; but should it be carried from one room to 
another, or when it sleeps, a blanket, or some wrap, 
ranging in weight with the season, will need to be 
thrown over it. 



90 OBSTETRIC NURSING. 

When a baby has but little hair on its head, and shows 
a tendency to catch cold readily, a plain cambric or light 
flannel cap may be employed as a head covering. This 
is a preventive against catarrhal troubles affecting the 
nose and throat. 

An outfit for babies which has obtained much favor 
among mothers is called the " Gertrude Suit" and 
consists of three garments : The first, or undergarment, 
is made of soft flannel, and is long enough to extend 
from the neck to ten inches below the feet. The next 
garment, cut in the same way, but half an inch larger 
and five inches longer, is made of muslin. Over these 
comes the " slip," also Princess style, and the only one 
of the garments with long sleeves. (This is the most 
objectionable feature of the suit; a baby's arms should 
be well covered.) It has a longer skirt than either of 
the other garments. All are fastened behind by small 
buttons. These three garments are put together and 
all slipped on to the baby at one time, facilitating the 
process of dressing very much. 

In our opinion, however, this suit has not the same 
advantages as that worn in the Maternity of the Woman's 
Hospital of Philadelphia, and first described. The fasten- 
ing of the clothing in front, the fewer number of articles 
comprising the wardrobe, and the fact that they may be 
very easily taken off and put on, while they meet all the 
requirements of warmth, looseness, and lightness, make 
this outfit preeminently a comfort to the baby. 

It is well to provide a lap-protector for the mother or 



PREPARATIONS FOR THE LABOR. 9 1 

nurse who shall have the baby in charge. This may be 
made of any thick wash material, and if shaped like a 
pillow-case, and fastened at one end by buttons, a piece 
of rubber sheeting can be slipped inside of it. The 
rubber can be slipped out and the case washed as often 
as necessary. 

The articles provided for the baby-basket may be the 
following : — 

Three or four pieces of linen bobbin, about eight 
inches long. 

A pair of blunt-pointed scissors. 

Large and small safety-pins. 

Several small squares of soft linen, about four inches 
square, for dressing the cord, and two inches square, for 
washing the eyes and mouth. 

A soft hairbrush. 

A powder-box and puff, with lycopodium or fine 
starch powder, or plain talcum. (The scented powders 
are often irritating.)* 

A small jar of cold cream. 

Two soft towels. 

A full suit of clothes, as described above, for the 
baby. 

A woolen shawl or wrap. 

* Many obstetricians discard the use of all powders for a baby's skin. 



CHAPTER VIII. 

SIGNS OF APPROACHING LABOR— THE PROCESS OF 

LABOR. 

Certain changes take place during the latter part of 
the ninth month which indicate that labor is approach- 
ing. One of these is the sinking of the abdominal en- 
largement. The upper part of the womb, which has at the 
beginning of the ninth month been high enough to reach 
the pit of the stomach, comes down gradually to a point 
about midway between the extremity of the breast bone 
and the navel. This sinking of the womb is known as 
" descent " or " settling " of the child, and indicates that 
the head of the child, which is ordinarily the part to be 
born first, has stretched the lower part of the womb and 
is finding its way into the cavity of the pelvis, through 
which it must pass in the birth. Great relief to the 
mother results from this descent of the womb, as the 
lungs are no longer pressed upon to the same extent as 
before. The change in the position of the womb pro- 
duces, however, an increased amount of pressure on the 
lower portions of the body. Swelling of the lower 
limbs is apt to result in consequence of this, and walking 
is rendered difficult. Piles, or hemorrhoids, are apt to 
form, and irritability of the bladder to exist. 

92 



THE PROCESS OF LABOR. 93 

During the last two weeks of pregnancy patients are 
apt to suffer from what is known as " false pains!' These 
are cramp-like pains, so much like labor pains that 
patients are often deceived by them, and led to imagine 
that the labor is really coming on. They are called 
" false pains " to distinguish them from the pains of labor, 
which are known as " true pains!' The way to distin- 
guish between the two kinds of pains is to observe 
whether there is any regularity as to the time of their 
occurrence ; also, whether the interval grows shorter, 
and whether, with this shortening of the interval, the 
pains grow stronger. " False pains " are irregular in 
their occurrence, while "true pains/' though starting 
perhaps at quite long intervals, as three-quarters of an 
hour or a half-hour apart, gradually come nearer to- 
gether and grow stronger. " False pains," also, are 
generally located in the abdomen. " True pains " more 
frequently start in the back, coming forward to the abdo- 
men and extending down the thighs. A strong " pain " 
is apt to be followed by one or two weaker pains. A 
nurse, if in doubt as to whether the pains are real labor 
pains or not, should have the physician sent for, who 
will make an examination to learn what the condition 
of the parts may be. A sign that makes it probable that 
the labor is really coming on is the appearance of what 
is known as the "show" a discharge of mucus, tinged 
with blood, which comes from the mouth of the womb, 
and indicates that the stretching of the mouth of the 
womb is taking place. 



94 OBSTETRIC NURSING. 

The whole process of labor is divided into three stages. 
The first is the stage of dilatation, when the mouth of the 
womb is stretching so as to allow the child to pass 
through it. With women who have never borne chil- 
dren this stage lasts on an average fifteen hours, while 
it is a very variable period for those who have previously 
borne children — sometimes lasting but three or four 
hours ; the average time given is from seven to eleven 
hours. 

The second stage of labor begins after the completion 
of the stretching of the mouth of the womb and ends 
with the birth of the child. For women with their first 
birth, this period lasts from an hour to an hour and a 
half; with others, from twenty minutes to an hour. 

The third stage of labor includes the interval between 
the expulsion of the child and the coming away of the 
afterbirth — on an average a half an hour or twenty 
minutes. 

The time for the entire labor, in a case where it is the 
first birth, is about seventeen hours. In cases where 
other children have previously been born, the average is 
from eight to twelve hours. 

The " bag of waters" is a sac of membranes in which 
the child is enclosed. Within this bag is found a liquid 
in which the child floats. The presence of this liquid 
between the child and the walls of the womb serves to 
protect it from the effect of falls or blows to which the 
mother may be subjected, and favors the regular devel- 
opment of the child. When labor begins with the 



THE PROCESS OF LABOR. 95 

stretching of the mouth of the womb, a small portion of 
this sac is pushed out like a wedge beyond the rim of 
the dilating orifice, and helps thus in the dilatation. 
When the waters break early, labor is much more tedious 
because the even pressure of the bag of waters on the 
mouth of the womb is lost, and the stretching cannot, 
therefore, go on so rapidly and easily. As the mouth 
of the womb opens, the pouch formed by the bag of 
waters is pushed further and further out into the vagina, 
the pains become stronger, and the pouch at last bursts, 
letting the water escape. This is " the breaking of the 
waters," called by physicians the " rupture of the mem- 
branes," and it should not take place before the mouth 
of the womb is fully open. 

Labor, however, sometimes begins with this loss of 
water, as has been said in the chapter on the Accidents 
of Pregnancy. 

The pains of the first stage of labor are cutting, grind- 
ing pains, very hard for the patient to bear, and causing 
her to be nervous and irritable. 

The cries made by the patient during the first stage of 
labor are very different from those of the second stage. 
They are cries of complaint and suffering, while during 
the second stage they are rather groans accompanying 
a bearing-down effort on the part of the patient. The 
pains of the second stage are called " forcing " or " bear- 
ing-down pains." An experienced woman will know, 
as soon as these pains begin, that the doctor should be 
on hand as soon as possible; and she should send him 



g6 OBSTETRIC NURSING. 

a message which will lead him to realize the necessity 
for coming at once. 

The pains during the' second stage increase in strength 
and frequency; the patient holds her breath and bears 
down forcibly with each pain. The effort causes her 
to become flushed and heated, and to break out into 
perspiration. 

During this time the head ,of the child is forced down 
the middle passage, or vagina, to the external opening. 
At the end of each pain, the head goes back a little, so 
that the birth-track may be very gradually stretched. 
With women who have previously borne children there 
is often so much relaxation of the tissues forming this 
passage-way that the head of the child may be expelled 
by a single pain. This sudden birth of the head often 
causes very serious tears. 

After the external opening has been sufficiently 
stretched by the slow advance of the head, it gradually 
works out altogether, and then the worst pain is over. 
There is then a short interval of rest before the re- 
mainder of the body is born, the shoulders coming first 
by a strong pain, after which the lower part of the body 
easily slips out. 

The contraction of the womb, or " pains," now ceases 
altogether from five to twenty minutes or even half an 
hour, when there is again a little pain and the afterbirth 
comes. 

The above description is an account of what labor 
should be if perfectly natural. There are many emer- 



THE PROCESS OF LABOR. 97 

gencies which may arise in any case, hence, for the sake 
of the patient and nurse, every effort should be made, 
even in what promises to be a normal case, to have the 
doctor on hand in time. 



CHAPTER IX. 
DUTIES OF THE NURSE DURING LABOR. 

With the occurrence of the symptoms which indicate 
the onset of labor the nurse, if not already in the house, 
should be immediately sent for. 

A nurse should give very prompt attention to such a 
call, and lose no time in getting to the patient, as many 
women pass through the different stages of labor very 
rapidly. 

On arriving at the patient's house, the nurse should 
put on her working- clothes, which should always be 
scrupulously clean and of wash material. The uniform 
worn by the nurses of the Woman's Hospital, of Phila- 
delphia, consists of a blue and white striped seersucker 
dress, very plainly made ; a large, plain white apron, with 
bib, well protecting the dress; over-sleeves, of same 
material as apron, for the protection of the dress- 
sleeves, and a white muslin Normandy cap. This makes 
a plain yet attractive dress — which is a matter of con- 
siderable importance to the patient, who gets her first 
impressions of her nurse through her personal appear- 
ance. 

Woolen dresses, or those made of any material which 

9 8 



DUTIES OF THE NURSE DURING LABOR. 99 

will not bear frequent washing, should never be worn 
by a nurse. There is always the possibility — in fact, the 
probability— of such a dress having been worn during 
her attendance upon some previous case of illness, in 
which case it would greatly endanger the patient. The 
feeling of the wash dress as it comes in contact with the 
patient's skin, when the nurse lifts her or works around 
her, is much more agreeable than that of woolen stuffs. 
Then, too, it is more businesslike, looks more like work, 
and gives the patient the comfortable feeling that a nurse 
means to help her, rather than to sit around as a fine 
lady, attending simply to the daintier duties of attendance 
upon the sick. I introduce this subject here because I 
find that many graduate nurses, in breaking their direct 
connection with their training-schools, set aside as a 
matter of small moment this requirement concerning 
dress — a requirement in which a most important prin- 
ciple is embodied and which demands the hearty sup- 
port of every truly scientific nurse. 

Another important point I wish to mention here, and 
that is, that a nurse should learn to dress herself quickly, 
so that she can slip into the necessary garments in a very 
few minutes, and thus, by her promptness in reporting 
for duty, awaken the confidence so essential to her man- 
agement of patients. 

On entering the room where the patient is to be found, 
while exchanging the necessary greetings, the nurse 
should exercise her powers of observation and rapidly 
take in the state of affairs, forming her opinion as to how 



IOO OBSTETRIC NURSING. 

far the labor has probably progressed. Should " pains" 
be occurring, she will recognize, from what has been 
said in a preceding chapter of the pains characterizing 
the different stages of labor, whether the patient is really 
in labor or not, also, how much time is probably left for 
the making of preparations. She can learn from the 
patient, in the intervals of her suffering, when the pains 
first began, how often they occur, whether the waters 
have broken, etc., so that she may know what message 
to send the doctor, should the necessity exist for so 
doing. After this duty has been performed, if labor has 
really begun, the nurse should give herself to the prepa- 
ration of the patient and the room for the confinement. 

Preparation of the Patient. — The nurse should 
inquire of the patient whether her bowels have been 
freely moved recently. If not, a simple enema of soap 
and water may be given for the purpose of clearing out 
the lower bowel and making the second stage of labor 
easier and cleaner. 

Inquiry should be made as to whether the patient has 
passed water freely. If not, she should be urged to make 
the attempt, and, if not successful, the physician should 
be notified. 

It is desirable, if there is time, to have the patient 
take a full warm bath and put on entirely fresh clothing. 

A vaginal injection of some antiseptic solution may 
then be given, and the parts about the external genera- 
tive organs washed off with an antiseptic solution. In 
the Woman's Hospital the vaginal injection consists of a 



DUTIES OF THE NURSE DURING LABOR. I CI 

solution of bichlorid of mercury 1-4000. The external 
parts are washed off with a similar solution of 1-2000 
or 1-4000. Other solutions may be used according to 
the choice of the attending physician. 

Preparation of Antiseptic Solutions. — Tablets of 
bichlorid of mercury may be obtained at any apothe- 
cary's, one of which, if added to a pint of water, will 
give, as a rule, a solution of 1-1000, from which solu- 
tions of varying strength may be made up by the addi- 
tion of more or less water. Thus, on adding seven parts 
of water to one part of the bichlorid solution 1-1000, 
a solution of 1-8000 may be obtained. It is always 
desirable that the nurse should have a little porcelain 
or agate-ware gill measure, by which she can readily 
and quickly prepare these solutions. If tablets cannot 
be obtained, powders of 7^ grs. each of bichlorid of 
mercury, if added to a pint of water, will give a solution 
of 1-1000. 

Creolin, a coal-tar preparation, four times stronger in 
its antiseptic properties than carbolic acid or lysol, may 
be used in place of bichlorid of mercury. To make these 
solutions, ^ to 1 dram of the liquid preparation should 
be added to the pint of water. Creolin and lysol, 
though not so strongly antiseptic as bichlorid of mer- 
cury, have greatly come into favor of late, both because 
they do not have the same corroding effect on instru- 
ments which may be used, and because there is less 
liability of poisoning than in the use of bichlorid of 
mercury. An objection has been raised to their use 



102 OBSTETRIC NURSING. 

for vaginal injections, as it is claimed that their admix- 
ture with blood produces a tarry precipitate. The 
coagulation of albumin in vaginal discharges, by the 
action of corrosive sublimate, is similarly claimed to 
deteriorate the value of the latter as an antiseptic agent. 
In cases where there is excessive discharge it may be 
better, therefore, to substitute a solution of perman- 
ganate of potassium, or carbolic acid. 

A nurse should never lose sight of the fact that the 
corrosive sublimate (bichlorid of mercury) tablets are a 
deadly poison, hence there should be no neglect as to 
care in their handling. 

Carbolic acid solutions are preferably used by some 
physicians. A two per cent, solution of the latter may 
be made up by adding 2 Y / 2 drams to the pint of water. 

When the patient seems to be in active labor, the nurse 
should keep her lying down until after the physician has 
made an examination. He will then state whether the 
patient may sit up or walk about the room. 

Because of her long confinement to bed the hair of 
the patient should be arranged so that it will be most 
comfortable and not readily tangled. The best arrange- 
ment is that of parting the hair down the back of the 
head and braiding it into two plaits — one behind each 
ear. This leaves a smooth surface at the back of the 
head to lie upon. 

The outfit of the patient during the labor should con- 
sist of a merino vest, long night-dress, a pair of large, 
roomy, open drawers, and a pair of stockings. While 



DUTIES OF THE NURSE DURING LABOR. IO3 

walking about the room, and until the second stage of 
labor begins, she can wear a wrapper over the rest of her 
clothing and have on a pair of bedroom slippers, which 
can be easily slipped ofif when she needs to He down. 

The patient should be told by the nurse of the neces- 
sity for an examination by the physician, particularly if 
this is her first labor. When the physician comes, the 
patient should be placed on the bed, near its edge, lying 
on her back or side, as he may prefer, with her limbs 
drawn up toward the abdomen. Her clothing should be 
lifted above the hips, and a sheet, or some light cover- 
ing, used to protect the lower part of the body from ex- 
posure. A chair should be placed for the physician on 
the same side of the bed, close to its edge, facing the 
patient as she lies ; a jar of cosmolin or vaselin should 
be brought him, and all the necessary materials provided 
for the proper cleansing of his hands both before and 
after the examination ; soap, nail-brush, w r arm water and 
towels, and some disinfectant solution, as a bichlorid of 
mercury solution of the strength 1-2000, or creolin, a 
dram to the pint of water, or lysol in the same propor- 
tion. 

The preparation of the room and bed will next require 
the nurse's attention. 

These preparations should be made as quietly as pos- 
sible. The nurse should have learned beforehand where 
things are, and she should have had them so arranged 
that but little will need to be done at the time, except to 
put them where they will be most convenient for use. 



104 . OBSTETRIC NURSING. 

It is well, if the patient is walking about, to have her go 
into the next room while the bed is made up. 

A single bed is always the most convenient in the man- 
agement of a patient, but such are rarely found in private 
houses. The preparation of a single bed would be as 
follows : First, the mattress — preferably of hair — covered 
by a pad and rubber-protective across the middle of the 
bed, or covering the bed entire. (Rubber army-blankets 
are used in the Woman's Hospital for this purpose.) 
The under sheet covers this rubber, and a draw-sheet — 
a sheet folded four times in its length and placed across 
the portion of the bed upon which the hips would rest — 
comes next. (The folded side of the draw-sheet should 
be toward the head of the bed.) This constitutes the first 
dressing, or what is known as the " permanent bed!' The 
different articles constituting this dressing are securely 
fastened down by safety-pins. Over the " permanent 
bed" comes the " temporary bed!' consisting of a second 
gum blanket, covering the entire bed, a second under- 
sheet and draw-sheet. Covering these are the upper 
sheet, blanket, and spread. 

After the confinement, the " temporary bed " can be 
drawn from under the patient, leaving her lying on the 
" permanent bed." The change is accomplished with 
much greater ease for both patient and nurse than the 
changing of the various articles separately. 

The double bed found in most private houses is ar- 
ranged as follows : First, the ordinary dressing of the 
bed, the hair-mattress, pad, rubber-protective, under- 



DUTIES OF THE NURSE DURING LABOR. IO5 

sheet, and draw-sheet. Upon top of this dressing, at the 
lower right-hand corner of the bed, a " temporary dress- 
ing " should be arranged, about a yard and a half square, 
consisting of a rubber protective, or the paper pad before 
described, securely fastened down to the bed beneath, 
and covered, if rubber, simply by a folded sheet, likewise 
fastened down by safety-pins. If the paper pad is used, 
an old comfortable or blanket will be needed beneath the 
sheet. The pillow for the patient should be. placed at 
the upper and inner corner of this square. After the 
delivery, she can be lifted to the upper part of the bed, 
and the " temporary dressing " removed. 

The sheet, blanket, and spread which are to serve as 
her covering after the delivery can be kept from soiling 
during the labor if folded upon themselves several times 
and carried to the extreme edge of the left side of the 
bed. Another sheet and blanket may be used as tem- 
porary covering during the delivery. It is so important 
that a patient shall be moved as little as possible imme- 
diately after the labor, because of the tendency to bleed- 
ing produced by motion, that the nurse should study 
carefully the best methods of protecting patient and bed 
from soiling, so that it will be necessary to do but little 
in the way of changing the clothing. 

The piece of floor oil-cloth must be spread at the side 
of the bed, extending from a foot to a foot and a half 
under the bed. 

There should be a bureau with a set of drawers, or a 
closet, with shelves, in the room, given up to the nurse 



106 OBSTETRIC NURSING. 

for the keeping of the various articles she may need, and 
these articles should be conveniently arranged so that 
there may be no confusion in obtaining them when re- 
quired at any time. One drawer or shelf should contain 
sheets ; another towels and napkins and soft, clean muslin 
or linen rags, to be used as napkins during the delivery ; 
a third should contain changes of underwear for the 
patient, and a fourth the baby's wardrobe. 

A change of clothing for the mother should be placed 
— if it is warm weather — in the sun by a window ; if in 
winter, by the register or stove, so as to be dry and warm 
should it be needed. 

The baby's suit should in the same way be aired and 
warmed. The baby's basket should be placed on a chair 
or stand near the register, with all the necessary articles 
for its toilet and bath — a baby's bath-tub or an ordinary 
foot-tub, soft towels, nurse's flannel bathing-apron, a little 
rendered lard in ajar, etc. Two pieces of bobbin, each 
eight inches in length, should be put in a little vessel 
containing some bichlorid solution, 1-4000. These, 
with a pair of blunt scissors, should be placed where 
they can be conveniently reached for the tying of the 
cord. Some small squares of soft muslin or linen should 
be placed where they will be convenient for the imme- 
diate cleansing of the child's eyes after expulsion of the 
head. A flannel blanket or good warm flannel petticoat 
should be provided for receiving the child upon its birth. 
The baby's crib should also be prepared for its reception. 

Beneath the bed there should be two chambers — one 



DUTIES OF THE NURSE DURING LABOR. IO7 

for urine and one for the afterbirth, or a tin basin may be 
provided for the latter. 

Some receptacle should be in readiness for the doctor's 
instruments, should they have to be used. The small 
pitcher which ordinarily accompanies the modern 
chamber sets serves very nicely for holding the obstetric 
forceps. 

A vessel for the patient to vomit in should be on hand 
— a chamber, or even a chamber-lid, will do very well. 

A basin filled with a zvarm solution of bichlorid of mer- 
cury, 1-4000 or 1-2000, should stand near the bed, or, 
if preferred, the creolin or lysol solution, so that the 
nurse or physician may repeatedly cleanse the external 
organs of generation of all discharges during the pro- 
gress of the labor. The solution in this basin should be 
frequently changed. 

A sufficient number of soft linen or muslin rags will 
also be necessary for this purpose. 

Agate, porcelain, or china basins are necessary when 
bichlorid solutions are used. For creolin or lysol ordi- 
nary tin basins will do. 

The nurse should never allow anything from the 
kitchen to be pressed into service for such an occasion. 
The indiscriminate use of pans, basins, cups, and saucers 
is certainly vulgar, to say the least. The " eternal fitness 
of things " should never be lost sight of. 

A urinal, or a soap-cup, which is a good substitute ; a 
glass catheter, and an English rubber catheter, No. 8 or 
No. 9 ; a bed-pan, and the other receptacles for the 



108 OBSTETRIC NURSING. 

various purposes above referred to, may be placed for 
convenience beneath the bed. 

A towel-rack near by should contain at least half a 
dozen fresh towels. 

A few napkins, a supply of soft rags, a zvaste-bucket or 
slop-jar, with a lid, should be found in the room ; and an 
abundant supply of hot and cold water. 

As soon as the patient is known to be in labor, the 
nurse should go to the kitchen to see that the fire is 
good, and that plenty of w.ater is put on to boil. An 
arrangement should also be made by which some mem- 
ber of the family will be prepared to respond t© the 
nurse's call for more hot water when it is required. The 
abdominal bandage for the patient, with the towel contain- 
ing the sterilized dressings and a pin-cushion containing 
safety-pins, should be placed on the stand beside the bed. 

A bottle of whisky or brandy, and one of hartshorn 
should be provided. 

A pitcher of cool water and a tumbler should be 
found in the room, as the patient may need a refreshing 
drink during the progress of the labor. A feeder is 
best provided for the patient's use, as she can then drink 
lying down. 

The arrangement of the patient's clothes to keep them 
from soiling during the expulsive stage of labor will 
require some care on the part of the nurse. The night- 
dress or vest should be folded or rolled up beneath the 
arm-pits and fastened with safety-pins over the right side 



DUTIES OF THE NURSE DURING LABOR. IO9 

of the chest. If the patient wears large drawers, no 
further protection than the cover-sheet may be necessary. 
Some prefer having a sheet adjusted around the waist, 
above the abdomen, and pinned under the clothing to 
the right side, the long end of the sheet which remains, 
and which should be the anterior part, is plaited up and 
fastened also beneath the right arm by means of safety- 
pins. The sheet thus resembles a skirt opened at the 
right side. 

During the Early Stage of Labor the nurse will need 
to encourage the patient, and by a sensible, quiet, yet 
cheerful bearing keep her strong. It is of no use for 
patients to hold their breath and bear down during each 
pain in this stage, and nurses should never urge their 
patients to do so. It should be left to the physician to 
decide when bearing-down efforts are desirable. The 
pressure of the nurse's hand upon the back during a 
pain often gives great relief to the patient, while the 
occasional bathing of the face and hands with cold water 
is refreshing. Frequent sips of cold water may be per- 
mitted. 

Nourishment in the form of beef-tea, gruel, milk, and 
tea may be given from time to time if the labor be long. 
No stimulants should be given without the direction of 
the physician. 

Vomiting is a troublesome though not necessarily a 
dangerous symptom during delivery. In fact, the relaxa- 
tion it produces is often desirable. If it is excessive, 
however, a little iced soda water may check it. 



IIO OBSTETRIC NURSING. 

Cramps in the lower limbs are a very frequent accom- 
paniment of the second stage of labor. Relief may be 
obtained by stretching the limb straight out, gently rub- 
bing the painful muscles, or grasping and holding them. 

Friends and Neighbors should, if possible, be ex- 
cluded from a confinement room. Their injudicious 
tales and expressions of sympathy are often absolutely 
painful. The nurse has to manage this with great tact. 
She can generally succeed best by stating to the friends 
that it is the physician's wish she could do so, and her 
relations toward the physician require that she should 
implicitly observe his directions. If the nurse does not 
allow herself to become familiar with her patients, but 
maintains a quiet dignity in the carrying out of her direc- 
tions, her requests will generally be observed. 

Tact is a magic wand by which human beings can 
accomplish miracles in the way of subduing the obsti- 
nate. Happy is the nurse who possesses it ! The best 
rule for acquiring it is the Golden Rule, " Do unto others 
as you would that they should do to you." A strict 
observance of this will insure a kindness of tone and 
manner in the making of requests which will win con- 
sent when it would not otherwise be granted. 

Duties of Nurse. — One of the most important duties 
of the nurse during the confinement is the frequent 
changing of napkins, draw-sheets, towels, etc., used about 
the patient. Also the frequent renewal of the antiseptic 
solutions to be used for her, or for the doctor's hands. 

Antisepsis means, literally, " against poisoning," and 



DUTIES OF THE NURSE DURING LABOR. I I I 

implies the careful removal of all sources of poisoning, 
such as would come from decomposing blood and dis- 
charges or dirty articles. The physician's and nurse's 
hands, therefore, require a special preparation for the 
labor in their thorough disinfection. During the course 
of the labor the hands should be thoroughly cleansed 
with a bichlorid solution whenever they have touched 
anything unclean, or whenever they come in contact 
with the genital organs. 

Position for Delivery. — The patient may be deliv- 
ered on her back or lying on her left side. When the 
physician desires the change of position, the nurse must 
help the patient to turn on her side and bring her hips 
close down to the edge of the bed. The upper or right 
limb will then have to be supported by the nurse, in 
order to well separate the thighs until the delivery is 
effected. (When there is insufficient help, a pillow may 
be used between the knees.) She will have to get on 
the bed close to the patient for this, and hold the leg at 
knee and ankle. After the child has come, she should 
help to turn the patient in the bed, bring a flannel wrap 
to put the baby in as it lies on the bed before the tying 
of the cord, and throw a covering over the mother's 
chest. She should then wipe the baby's eyes with a fine, 
soft piece of linen dipped in tepid water, or a saturated 
solution of boric acid; should bring the doctor the scis- 
sors and bobbin, and have ready a sheet for receiving 
the child and a vessel for the afterbirth. She should 
hold the sheet doubled upon her outstretched arms, the 



112 OBSTETRIC NURSING. 

side toward her being held up by her chin. On receiv- 
ing the baby with its flannel covering, she allows the 
edge of the sheet held up by her chin to drop down 
over the child. She then folds over the hanging ends, 
so as thoroughly to cover the child, and places the 
little bundle in a crib, to await further attentions, until 
the mother has been made comfortable. Should the 
child breathe imperfectly, the physician will give it his 
own attention or direct the nurse what to do. 

Disposal of Afterbirth. — The vessel containing the 
afterbirth, if the latter has been detached from the child, 
may be placed temporarily under the bed, to await the 
physician's examination. If the cord has not yet been 
tied, the vessel may be put in the crib with the baby. 
Many physicians do not tie the cord or navel-string 
until there is no further pulsation in the vessels. 

Attentions after Labor. — Should the physician not 
desire to do so, the nurse should next attend to the 
cleansing of the mother's external parts by means of soft 
cloths dipped in a solution of bichlorid of mercury 
1-4000, or whatever solution the doctor may direct. 

Many physicians make a practice of using a vaginal 
injection of some disinfectant solution immediately after 
delivery. It will be the nurse's duty to prepare this 
should it be called for. The " temporary dressing " 
should be removed from the patient, and she should be 
gently lifted on to the upper portion of the bed. The 
binder and dressings must next be applied. 

The binder must be rolled up to half its length, and 



DUTIES OF THE NURSE DURING LABOR. I 1 3 

the rolled portion passed beneath the patient's back. It 
is then caught on the other side and unrolled, straight- 
ened so as to be free from wrinkles, and made to encircle 
the hips tightly. The overlapping ends are then fastened 
together by means of safety-pins down the front. The 
middle portion of the bandage should be tightened first, 
as the firmest pressure should be directly over the 
upper portion of the womb. The lower portion of the 
bandage is fastened next, and the pins in the upper 
portion placed last, as this does not need to be so firmly 
applied. 

The antiseptic dressings should next be applied in the 
order described in the preceding chapter. The napkin 
is spread out and fastened to the abdominal bandage 
anteriorly, so as to fit over the convexity of the upper 
portion of the external organs of generation and extend 
from groin to groin. Posteriorly it is fastened to the 
abdominal bandage by but one safety-pin. This makes 
an " occlusion dressing." 

The patient's body-clothing should then be unfastened 
and drawn down (her drawers and stockings should 
have been removed with the " temporary dressing "). 
The coverings of the bed are drawn up over her, and she 
is allowed to lie quietly until the nurse cleans up the 
room and makes preparations for washing the baby. 

The physician generally remains with the patient an 
hour after the delivery, taking her temperature and 
pulse, and watching the condition of the womb, to insure 



114 OBSTETRIC NURSING. 

against danger of hemorrhage from want of proper con- 
tractions. 

After the doctor leaves, this duty devolves upon the 
nurse, who should examine the dressings frequently to 
see that the bleeding is not too profuse, and place her 
hand over the lower part of the abdomen to feel the 
womb, which, if properly contracted, should be a round, 
hard body about the size of a child's head, immediately 
above the pubic bone, and not reaching higher than the 
navel. The consideration of the accidents of labor and 
the care of the infant will be treated in other chapters. 



CHAPTER X. 
ACCIDENTS AND EMERGENCIES OF LABOR. 

Women who have borne children before are apt to 
have rapid labors , hence a nurse should be on her guard 
when in attendance upon such a patient, watching for 
the symptoms of approaching labor, and notifying the 
physician earlier than she would feel warranted in doing 
with a patient expecting her first confinement. As soon 
as the nurse suspects that labor pains have begun, she 
should put her patient to bed. When " bearing-down " 
pains begin, the patient should not get up even to use 
the chamber. A bed-pan should be used. The patient 
should not be allowed, when the pains come on, to catch 
hold of anything to increase the force of her effort. 
Above all, the nurse should not tell her to bear down. 

The strength of the pains is somewhat modified if the 
patient is kept on her side. This position is also safer for 
the perineum, which does not so directly get the full 
force of a pain as when the patient lies on her back. 
The left side is preferable, as it enables the nurse to use 
her right hand to greater advantage. 

Should the child's head come down so that it can be 
seen at the entrance to the vagina, the nurse should place 

1*5 



Il6 OBSTETRIC NURSING. 

herself on the right side of the bed, and as the patient 
lies on her left side, with the hips well drawn to the edge 
of the bed, the nurse should gently hold back the baby's 
head during a pain. This is to prevent a tear from oc- 
curring by the sudden expulsion of the head. She should 
favor the gradual stretching of the parts. She should 
avoid interfering in any way, as in making efforts to 
enlarge the opening by stretching it with the fingers, etc. 
All such attempts will inevitably result in harm. When 
the opening is sufficiently stretched, the head will slip 
out of itself. The passage of the child's head is ren- 
dered easier if the patient's knees are separated by a 
pillow. The nurse should simply continue to support 
the head with her hand, and as soon as the head is born 
her left hand should be placed over the mother's abdo- 
men, resting upon the womb, which may be distinctly 
felt through the abdominal walls. The pressure of the 
hand acts as a stimulant to the womb and induces good 
contractions. A tendency to hemorrhage is thus averted. 
The right hand of the nurse should support the child's 
head. With one finger she should feel around the baby's 
neck to learn whether it is encircled by a loop of the 
navel-string or cord. If so, she should gently pidl first on 
one side and then on the other, of the cord y to see which 
end gives. This loosens the pressure and prevents the 
stoppage of the circulation in both cord and child's neck. 
When, after a pause, the pains start up again to expel 
the rest of the child's body, the nurse had better have 
some one instructed how to hold the womb properly, as 



ACCIDENTS AND EMERGENCIES OF LABOR. \\J 

both her own hands will be needed to receive the body of 
the child as it is expelled. The mother herself may be 
shown how to make this pressure over the womb. If 
there is no one to make this compression of the womb, 
the nurse should try to manage the baby with one hand 
and keep up the pressure over the lower part of the 
abdomen with the other. The flannel wrap for the baby 
may be put close up to the mother's hips, and the nurse 
can manage with one hand to lay the baby down on this, 
cover it up, and draw it far enough away from the 
mother's hips to keep it out of the discharges. She 
should see that the baby s mouth is free from liquids. The 
little finger of her right hand acting as a hook, the end 
of the finger should be passed in at one corner of the 
baby's mouth and out at the other corner, thus scooping 
out any liquids that may have been drawn in during the 
birth. She should be careful to see that the cordis not 
dragged upon and that the baby breathes ivell. Babies 
usually cry lustily just after the birth. This should be 
a welcome sound to both nurse and mother, as it ensures 
expansion of the lungs. Occasionally, a child will be 
born with what is known as a " veil" or "card" — a por- 
tion of the membranes drawn tightly over the face. 
This may cause death from suffocation unless it is 
quickly seized by the fingers and torn off, so as to free 
the child's mouth and nose. 

Resuscitation of Baby. — If the baby is apparently 
lifeless when born, besides the measures spoken of for 
clearing its mouth of liquids, it may be turned over 



I I 8 OBSTETRIC NURSING. 

on its face, to empty out the discharges from the air- 
passages, and efforts should be made to start breathing. 
The head of the child should be lowered, to keep as much 
blood there as possible. 

The back may be slapped— several short, quick slaps 
given over the buttocks. A stream of cold water may 
be poured on the chest just for a moment, and this 
repeated several times. 

If these measures fail, the nurse may breathe into the 
baby's month. To do this properly, the baby's nose should 
be held, the nurse's lips placed closely over the baby's 
open mouth, as she breathes into it, then the nurse's 
mouth is removed and the grasp on the nose loosened, 
the sides of the child's chest being pressed upon to 
press out the air. The number of breaths given by the 
nurse in a minute should not at first exceed twelve. 

Byrd-Dew Method. — A most valuable method of 
carrying on artificial respiration, recently revived, is that 
known as the Byrd-Dew method, the different move- 
ments of which are well shown by the accompanying illus- 
tration. The operator holds the neck of the child between 
the thumb and the index finger of one hand, while the 
other hand holds the child at the nates. The first step (A) 
is to flex the body of the infant along its dorsal surface 
as much as possible, bending the spine well backward; 
then gradually to flex it upon its ventral surface, bring- 
ing the head in close apposition to the lower extremities 
(B, C). In the first movement the diaphragm is pulled 
down mechanically, as a result of the descent of the 





Fig. 15.— Byrd-Dew Method of Artificial Respiration. 



119 



120 OBSTETRIC NURSING. 

abdominal organs. We thus imitate inspiration, and 
during the manipulation may often hear air entering the 
trachea. As the body of the child is bent forward, the 
diaphragm is pressed upward and the walls of the chest 
are compressed. Thus the expiratory act is accom- 
plished; and, during it, not only air is driven out, but 
the mucus and amniotic liquid that may have entered 
the air-passages. 

These movements may be carried on while the sur- 
face of the child is kept beneath hot water the greater 
part of the time — which is a decided advantage over 
some of the other methods of resuscitation, especially 
in asphyxia of the second degree, when the surface ot 
the child is very pale, showing it to be suffering greatly 
from shock. It is always important in such cases to 
keep the body of the child warm. The movements 
should not be too rapidly performed — about three times 
to the minute is often enough. 

Schultze's Method. — A third method is known as 
Schultze's method. In this, as in the Byrd-Dew method, 
the early and quick tying of the cord is necessary, as it 
is only of advantage when practised immediately after 
the expulsion of the child. The method is as follows : 
The child is seized by the shoulders arid upper arms 
and swung head downward above the operator's head. 
The weight of the lower part of the body is thus thrown 
upon the chest, and any liquids which may have been 
drawn into the air-passages are thus forced out. Being 
held thus for a time, while the operator counts five, the 



ACCIDENTS AND EMERGENCIES OF LABOR. 121 




Fig. 16. — Schultze's Method of Resuscitation (First Movement' 



122 



OBSTETRIC NURSING. 



body is then brought down in reversed position be- 
tween the operator's knees. The weight of the lower 



O 




Fig. 17. — Schultze's Method of Resuscitation (Second Movement). 



extremities is thus made to drag upon the chest 
and enlarge its capacity for the entrance of air. These 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 23 

two movements may be kept up for a considerable 
time.* 

Alternating with artificial respiration, warm baths may 
be employed from time to time. The temperature of the 
bath should be ioo° Fahr. After breathing is estab- 
lished, the child should be placed in warm wraps, with 
bottles of hot water around it. 

Method of Prochownick, of Hamburg. — A method 
of resuscitation that has been employed with great suc- 
cess for many years by Prochownick, of Hamburg, in 
the severer grades of fetal "asphyxia, is carried out as 
follows : As soon as delivered, the child is seized by its 
feet, as shown in Fig. 18 ; the child's forehead is allowed 
to rest lightly on a table or some other surface, the face 
being extended, so that the chin is thrown well forward 
and the trachea, or windpipe, freed from all compression. 
The mouth in this position hangs open. While an as- 
sistant holds the child in this position, the operator 
grasps the chest with both hands (see Fig. 18), and 
makes compression over it, thus imitating the act of 
expiration, by which discharges drawn into the air-pas- 
sages may be expelled. A relaxation of this compres- 
sion permits expansion of the chest, and thus inspiration 
is effected. These movements are carried on rhythmi- 
cally until natural breathing is established. When an 

* The order of these movements as given by Schultze is reversed. The 
upward movement is practised first in the Woman's Hospital, as it is found 
that the air-passages are thus best cleared of mucus and discharges before 
an act of inspiration is encouraged. 



124 



OBSTETRIC NURSING. 



assistant can not be had, the manceuver can be carried 
on as shown in Fig. 19, by means of one hand, although 
less efficiently. 




Fig. 18. Fig. 19. 

Prochownick's Method of Resuscitation. 



Laborde's Method. — Still another new method of re- 
suscitating an infant has been employed of late in France. 
The tip of the tongue being seized by means of a towel 



ACCIDENTS AND EMERGENCIES OF LABOR. 125 

and held between the fingers, or by means of the ordin- 
ary tongue forceps, the organ is drawn well forward 
and then pushed backward. Rhythmical movements of 
the tongue are thus kept up until respiration is estab- 
lished.* 

Relapses after resuscitation are very common — hence 
a child will need to be watched very closely after such 
measures have been employed, until sufficient time has 
elapsed to fully persuade both doctor and nurse that 
the action of the respiratory apparatus is normal. For 
at least twenty-four to forty-eight hours a resuscitated 
child should have a special attendant, whose business it 
will be to watch it. If not doing well, such care may be 
needed for a longer period. 

Tying of the Cord. — If all is well with the child, 
it is best not to tie the cord until all pulsation ceases in 
it. This measure is thought to save the child some loss 
of blood. As the pulsation may last for an hour or 
more after the delivery, the afterbirth is generally ex- 
pelled before the cord is tied. To tie the cord, two 
pieces of bobbin, each eight inches long, dipped in a 
bichlorid solution (1-4000) or in some other antiseptic 
solution, should be used. The first ligature should be 
placed three inches from the child's abdomen. The 
string should be carried underneath the cord. In 



*The Marshall Hall and Sylvester methods of resuscitation are more 
efficacious when employed for adults than in the case of infants, hence 
have not been considered in this connection. 



126 OBSTETRIC NURSING. 

making the first tie, two twists instead of one should be 
taken to keep it from slipping. If the thumbs are 
placed upon the string in tying, the ligature can be 
drawn more tightly, and the grasp of the ends of the 
bobbin is more secure. The second knot is tied the 
same way. The ends may then be looped, making a 
bow-knot. The cord should be stripped, that is, the 
blood remaining in the vessels squeezed out toward the 
afterbirth, before each ligature is thrown around it. The 
second ligature is one inch further away from the inser- 
tion of the cord into the child's abdomen. After this 
second ligature is tightened, hold the cord with the fore- 
finger and middle finger at the ligature nearest the 
child, the thumb and other fingers at the other ligature, 
and cut it with a pair of dull scissors between these 
points. The extremities of the'scissors are thus made to 
look toward the palm of the hand, and a sudden move- 
ment on the part of the child does not result in the same 
danger to it as there would be were the points not thus 
protected. After the cord is cut, squeeze the remaining 
blood out from the end next the child. The scissors for 
this purpose are preferably dull, as the more ragged 
wound thus produced favors the closure of the blood- 
vessels. This lesson maybe learned from nature, the 
lower animals gnawing off the cord after giving birth to 
their young, and thus no doubt decreasing the danger of 
bleeding. 

Position for Delivery of Afterbirth. — The best 
position for the mother during the delivery of the after- 



ACCIDENTS AND EMERGENCIES OF LABOR. 12/ 

birth is on her back, hence she may be turned after the 
nurse has satisfied herself that the baby is in good con- 
dition. 

Twins. — Very occasionally, on placing her hand over 
the abdomen, after the delivery of the child, the nurse 
may feel another child there. In this case she must 
simply keep the womb well contracted by rubbing it 
gently through the abdominal walls, and wait for na- 
ture to go on with the work of expulsion. This baby 
must be cared for as the other. 

The afterbirth generally comes away within twenty 
minutes after the child's birth. Two or three pains 
occur, during which the nurse should keep the womb 
in the middle line of the abdomen and make gentle 
pressure backward and downward. With her right 
hand she should seize the afterbirth and membranes and 
twist them around several times to make a cord of the 
membranes, so that they may not tear, but all be ex- 
pelled at once. A discharge of blood and some clots 
generally follows the delivery of the afterbirth. The 
nurse's left hand should still be kept carefully over the 
womb, which should feel hard and firm and should not 
reach above the navel. If it does not feel firm, rubbing 
over the lower part of the abdomen should again be re- 
sorted to until the round, hard body is felt. 

If the afterbirth does not come for an hour, and the 
physician has not yet come, send for another doctor. 

After the afterbirth has come, it should be put in a 
clean vessel, and, if detached from the baby, put in an 



128 OBSTETRIC NURSING. 

adjoining room for the doctor to examine when he 
comes. Insist upon his seeing it, to find out whether 
it is all there. Have the baby removed to its crib and 
placed on its right side and properly covered. 

After-care. — Watch the womb carefully until the 
doctor comes. If it be firmly contracted, and no more 
blood be flowing from the vagina, place some dry nap- 
kins or a clean sheet under the patient, and wash oft 
the thighs and surrounding parts with warm water con- 
taining bichlorid in the strength of 1-4000, and dry with 
a soft cloth. 

Slip the soiled clothing from under the patient, and 
then apply the binder and dressings, and make her 
comfortable. 

As soon as the doctor comes, report to him the exact 
time when the waters broke, when the baby was born, 
and when the afterbirth came. It is always best for a 
nurse to keep a written report with a statement of what 
she did. She should not, however, neglect her patient 
for the purpose of perfecting her report. 

Breech Delivery. — Sometimes a nurse has the mis- 
fortune to be the only attendant at a breech delivery; 
that is, instead of the child's head coming first, the 
breech passes out from the birth-canal. Delivery in 
this manner is very dangerous to the life of the child. 
The nurse should do absolutely nothing here, as she 
would only make matters worse in trying to assist. 
These deliveries are long enough, as a rule, to give 
ample time for the summoning of some doctor to take 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 29 

charge of the case. In all breech cases the child is apt 
to need to be resuscitated, if it is alive at all ; hence 
plenty of warm water, etc., should be ready for the bath. 

Hemorrhage. — Flooding from the womb, or " uterine 
hemorrhage," is apt to occur either within the first 
twenty-four to forty-eight hours after the birth, when it 
is called "primary hemorrhage"; or, it may occur some 
days after, when it is " secondary hemorrhage." The 
appearance of blood, either a constant oozing or a sud- 
den gush from the vagina, is, of course, the earliest 
symptom. 

A pulse of over ioo in a patient freshly confined 
should make the nurse exceedingly watchful in this 
respect, as it betokens a liability to hemorrhage. Should 
the flow continue, the patient becomes pale, faint, rest- 
less, gasps for breath, and finally dies unless the hemor- 
rhage is checked. A nurse should, of course, have the 
physician sent for at once, although he may have just 
left the house, or another doctor should be summoned. 
In the meantime, her first thought should be of the 
uterus and its probable condition of relaxation. The 
bandage, if applied, should be hastily removed, and the 
hand placed over the lower part of the abdomen. If the 
womb is not felt, rub vigorously until it contracts and is 
felt again as a round, hard body. Keep on rubbing and 
holding. The nurse should never take her hand off the 
abdomen until the doctor comes. Direct some one else 
to take the pillows from under the patient's head, have 
the foot of the bed elevated, to keep the blood in the 
9 



13° 



OBSTETRIC NURSING. 



head and prevent fainting, which induces heart-clot. 
Have the foot of the bed placed on the seats of chairs. 
The patient may be fanned, cold water given her to 
drink, hartshorn to smell. She should not be allowed 
even to turn in bed or lift her head. If the doctor has 
left ergot, one teaspoonful of the fluid extract may be 
given in a tablespoonful of water. The patient should 




Fig. 20.— Position of Patient in Hemorrhage after Labor. 



receive this without lifting her head. Plenty of hot 
water should be on hand, the water in the tea-kettle 
boiling. If the physician delays his coming and the flow 
continues, repeated hot- water injections of about 115 °— 
120 should be given into the vagina. 

Convulsions may come on during the labor as during 
the pregnancy. Their management would be the same 
as that suggested for convulsions during pregnancy. 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 3 I 

Other accidents, such as rupture of the uterus, or the 
coming down of an arm or hand, or the navel-string in 
advance of the usual part to come first, are conditions 
in which the nurse can do nothing, except to keep the 
patient as quiet as she can, and meddle as little as pos- 
sible until the doctor comes, for whom, of course, she 
must at once send. 

Deportment. — At no time, in the management of a 
case, should a nurse express surprise or consternation, 
nor should her manner indicate that she has such feel- 
ings. Like a true soldier, she must bravely and quietly 
face the most critical situations and meet their demands. 
She should by her manner give the mother to feel that 
all life's vicissitudes are best met by a quiet self-control. 

Fortunately, deaths during delivery in this enlightened 
age are few ; for the methods of averting accidents at 
such times have been so thoroughly studied that acci- 
dents themselves are very rare. 

Obstetric Operations. — As operative procedures 
during the course of a delivery may have to be resorted 
to very suddenly and unexpectedly, a nurse should have 
things in readiness should the emergency arise. The 
especial preparations necessary will consist in the making 
of a cone of stiff paper, into which a towel is fitted, for 
the purpose of giving the patient ether; arrangements 
for an abundant supply of hot water, to be had at a 
moment's notice; facilities for making up antiseptic 
solutions quickly; a small pitcher containing a warm 
one per cent, creolin or lysol solution for the physician's 



132 OBSTETRIC NURSING. 

instruments; English rubber catheter and urinal con- 
veniently at hand ; a basin with a one per cent, carbolic 
or a lysol solution for needles, sutures, and scissors ; 
absorbent cotton in small pads, or soft linen rags dipped 
in an antiseptic solution, to be used instead of sponges ; 
sufficient protection for the floor at the side of the bed ; 
and preparations for resuscitation of the infant. 

The position of the patient for most obstetric opera- 
tions will be across the bed, with her hips well over the 
edge. This is called a "cross-bed." Physicians gener- 
ally call simply for a cross-bed, in desiring the nurse to 
make preparations for an operation, and she should 
understand that this refers to the arrangement of pro- 
tectees and sheets, adjustment of pillow, and placing of 
patient in proper position. Should there not be a suffi- 
cient number of persons to have one hold each leg, 
chairs should be placed in such a way at the side of the 
bed as to support the widely separated feet. A chair 
for the physician should be placed between these, facing 
the bed. As there is usually some assistant to give the 
ether, the nurse will need no help in keeping the limbs 
apart and in giving the physician any other aid she can 
in the supply of the various articles as they are needed. 
Should the physician desire her to give the ether, her 
whole attention should be devoted to administering the 
anesthetic and seeing that the patient keeps in good con- 
dition. Strict watch should be kept over the respira- 
tions and the pulse. Difficult breathing, or a stoppage 
in the respirations, weakness or irregularity of the pulse, 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 33 

blueness of the face and lips, should at once be called 
to the physician's notice, the ether cone being removed 
from the patient's face. After the patient is once well 
under ether, it takes but little to keep up the anesthesia, 
so that the nurse should use the ether sparingly ; a few 
drops every few minutes upon the towel are, as a rule, 
sufficient. After etherization the patient may vomit, and 
there will be greater tendency to bleeding because of 
the relaxation induced by the anesthesia, hence the nurse 
should exercise special watchfulness and care over the 
patient. The vomiting is often relieved by a mustard 
paste over the stomach, while the bleeding may be con- 
trolled by the hand placed over the lower part of the 
abdomen, which, by making pressure over the womb, 
insures good contractions. After the nausea is relieved, 
ergot, if prescribed by the physician, may be given. 



CHAPTER XI. 
MANAGEMENT OF THE LYING-IN. 

Immediately after the delivery it is necessary that the 
patient should have rest. The room should be kept ex- 
ceedingly quiet and the shades drawn down so as to sub- 
due the light. 

The patient may be allowed to sleep, but the nurse, 
during this time, should watch her very carefully, as 
there is a liability to bleeding when the sleep is too deep, 
owing to the general relaxation induced by sleep. She 
should draw the bedclothes up at one side from time to 
time, to see how much blood is lost. 

There should be no unpleasant smell about a confine- 
ment room, plenty of fresh air should be allowed to 
enter, and all discharges should be at once removed 
from the room. 

While the patient sleeps, and after the child has re- 
ceived proper attention, the nurse should place the 
soiled sheets, towels, and all articles stained with blood in 
cold water to soak. 

The afterbirth, also, should be disposed of. If in the 
country, it should be buried in a hole dug in the yard, 
two or more feet deep. It should never be thrown 

134 



MANAGEMENT OF THE LYING-IN. 1 35 

down a water-closet or privy. In the city it is best to 
burn it at night. It may be put in the range or stove 
and well covered up with coals. Clots of blood may 
safely go down the water-closet, as they readily dissolve. 

To return to the soiled clothing left after a confinement 
— though a trained nurse will not often be called upon 
to attend to the washing of these articles, there will be 
times when it would be better that she should do so, 
both to save the patient expense and trouble and to 
prevent their lying about too. long. At any rate, she 
should know how it should be done. Should the cloth- 
ing be put to soak before the blood has dried into it, 
and allowed to remain for a few hours, the water being 
changed as often as needed, the washing will not be 
difficult. 

As a rule, it is not best that a nurse should leave her 
patient or the baby long enough to attend to this wash, 
hence it is advisable to have it put out or done by some 
one else in the house. The soaking ought, however, 
always to be attended to by the nurse, because it facili- 
tates the subsequent washing. 

In the after-care of the patient the nurse should attend 
to the washing of the mother's and baby's napkins. She 
should, if needed, wash the baby's flannels and slips. 

Visitors. — For a week a newly-confined patient should 
see no visitors. Even the husband should not remain 
in the room long at a time. No painful or exciting news 
should be communicated to the patient, as a distressing 
form of mental trouble to which lying-in women are 



I36 OBSTETRIC NURSING. 

prone may be thus induced. This is known as " puer- 
peral mania." 

Food. — After the patient rouses from her first sleep 
she is generally hungry. The nurse should have learned 
from the physician before he left what he would prefer 
her having. A cup of warm milk or tea — not too hot — 
may be given directly after the confinement when ether 
has not been taken, and this followed in three or four 
hours by alight meal, as toast and tea or gruel. With 
regard to the diet of the lying-in, nurses must be pre- 
pared to follow the rules of the physicians for whom 
they work. Some physicians allow considerable variety 
in the food from the beginning. 

The following directions concerning the diet are given 
to the nurses of the Woman's Hospital : " It should be 
remembered, in the diet of the lying-in woman, that the 
amount of liquids, should the breasts or nipples threaten 
to give trouble, must be limited, not only until after the 
secretion of milk, but also until the supply of milk adapts 
itself to the demand, for the first five or six days after 
the confinement. 

As soon as the patient is made comfortable after the 
birth, she should have a cup of warm milk or weak tea, 
or warm water and milk. 
First meal-time : Plate of milk toast or bowl of oatmeal 

gruel, or saucer of wheat germ or boiled rice. 
Second meal : Cup of weak tea or warm milk, dry toast, 

or milk toast, or water toast, or soda crackers soaked 

in hot milk. 



MANAGEMENT OF THE LYING-IN. I 37 

Third meal : Saucer of oatmeal mush or wheaten grits, 

with a cup of tea or warm milk, with Graham biscuit 

or dry toast. In normal cases a little stewed fruit 

may be given with the evening meal, even on the first 

day. 
Forenoon, afternoon, bedtime : Lunch, a cup of warm 

milk, with a piece of dried bread or Zwieback. 
Second Day. — The same as above. 
Third Day. — The same, with the addition of stewed 

apples or baked apples for supper, if not given before. 
Fourth Day. — Breakfast : Soft-boiled egg, dried bread, 

stewed fruit, and cup of milk or weak tea. 
Dinner: Plain beef or mutton-broth, dried bread, and 

farina or junket. 
Supper : Baked apples or stewed prunes, saucer of wheat 

germ, and Zwieback. 
Fifth Day. — Breakfast : Cup of weak coffee or cocoa, 

mutton-chop, oatmeal mush, dried bread, and a sweet 

orange or ripe apple. 
Dinner : Beef or mutton-broth or oyster-stew, baked 

potato, stewed tomatoes, dried bread, farina, junket, or 

rice. 
Supper : Stewed fruit, Indian-meal mush, and Zwieback. 
Sixth Day. — Ordinary plain diet, avoiding salads, sour 

fruit, fried or highly-seasoned meats, fancy desserts, or 

sweets of any kind. 

This holds good of all subsequent meals. The above 
dietary will require to be modified when special indi- 
cations arise. Should the patient's temperature rise to 



I38 OBSTETRIC NURSING. 

ioo° Fahr., or above, she should be kept on liquid diet, 
as milk and beef-tea alternately every two hours until 
the physician directs otherwise. 

As liquids favor the secretion of milk, liquid food 
should constitute a large proportion of the nourishment 
taken by nursing women throughout the lying-in, pro- 
vided there is not a tendency to over-secretion. The diet 
should be plentiful and nutritious, but selected carefully 
with reference to its digestibility. As the patient must 
remain inactive for some time, it will not do for her to 
eat the starchy vegetables, pastry, or warm breads, for 
all these require very active powers of digestion. 

A nurse should thoroughly understand the artof 
cooking, and be able to provide her patient with palatable 
and nutritious dishes, daintily and prettily served on a 
tray, until, with the physician's consent, she takes her 
place at the family table. Even then a nursing woman 
will need to receive some nourishment, as gruel, beef-tea, 
milk, etc., between the regular meals, for she must not 
only provide for herself, but for her child. 

Duration of Lying-in. — The lying-in lasts six weeks. 
During this time the organs of generation are returning 
so far as possible to their former condition. It is im- 
portant that the patient should have rest, and for at 
least two weeks of this time should be in bed. 

Involution. — The process of changes by which the 
womb shrinks to its normal size is known as " involu- 
tion!' This process is favored by the patient lying as 
much as possible on her back, so that the womb does 



MANAGEMENT OF THE LYING-IN. 1 39 

not incline too much to one side or the other. The 
patient may be carefully propped up a little by pillows 
on the third or fourth day, so that she shall be in a 
semi-reclining position. This facilitates the drainage of 
the uterus. Care must be taken not to permit her to 
move herself too much, as a hemorrhage may be thus 
started. The progress of involution is determined by 
the height of the uterus as appreciated by palpation 
over the lower part of the abdomen. Under the most 
favorable conditions the uterine fundus will be found to 
correspond in height with the following points : — 

Twenty-four hours after labor, — on a level with the 
umbilicus. 

Second and third day, — midway between umbilicus 
and symphysis pubis. 

Fifth and sixth day, — three fingers' breadth above the 
pubic symphysis. 

Ninth and tenth day, — on a level with the pubic 
symphysis. 

A full bladder or a full rectum will prevent proper 
contraction and decrease in size of the uterus, as also 
will subinvolution from former uterine disease of any 
kind, or from inefficiency of the uterine muscular tissue. 

The Lochia. — The discharges of the mother con- 
tinue about two weeks, and they are called the " lochia!' 
For the first twenty-four hours they are blood; the 
second and third day, watery blood; from the fourth to 
the sixth day they have a greenish-yellow coloration, 
and from the tenth to the twelfth day they become 



I4O OBSTETRIC NURSING. 

white. This white discharge may continue for a long 
time after the confinement. The character of the dis- 
charge will indicate the process of involution, hence the 
physician should see daily tjie napkins or dressings re- 
moved from the patient. Soiled napkins and dressings 
should never be kept in the patient's room, but in some 
closed vessel, as a clean chamber or a slop jar, with a 
close-fitting lid, in another room. The existence of the 
least odor about the discharge should at once be 
brought to the physician's attention. If napkins are 
used, they will need to be changed during the first day 
about every two hours, sometimes oftener ; the second 
and third day, about every three hours ; the fourth and 
fifth day, every four hours ; until, by the tenth day, about 
three changes are sufficient. The antiseptic dressings 
are changed, as a rule, every three hours until the dis- 
charge ceases. If it be very scant, a change once in 
six hours may be sufficient. These antiseptic dressings 
should be burned. The napkins should be soaked in 
cold water until the blood is well out of them, and then 
thoroughly washed and boiled. The boiling is suffi- 
cient, if properly done, to render them aseptic, but, as 
an additional precaution, they may be wrung out in a 
1-2000 bichlorid solution before drying. The patient 
should be washed off each time the napkin is changed with 
a warm antiseptic solution, as 1—4000 of the bichlorid 
of mercury, or a lysol solution of 1 per cent. Care 
should be taken not to irritate the parts. Instead of 
using a soft cloth to wash off the parts, the water may 



MANAGEMENT OF THE LYING-IN. I4I 

be poured in a small stream over them, and a soft, dry- 
cloth pressed gently over them to remove all moisture. 
Especial care should be taken where there are stitches 
not to pull them in any way. 

Bathing. — One daily^washing of the entire body is 
as a rule, desirable. The doctor's advice, however, 
should be asked concerning the matter. This wash, 
when given as a sponge-bath, need not exhaust the 
patient, nor cause too much movement of her body. 
The patient should never feel chilly during this bath ; 
should she do so, the bath must at once be stopped. 
The bath should, of course, be given under cover. The 
increased activity of the skin necessitates especial clean- 
liness, and the daily bath is found, when properly given, 
to be very refreshing. Frequent changes of bed and 
body clothing, too, are necessary — the body clothing, if 
possible, daily until the discharges cease. 

Attention to Bladder. — The bladder is frequently 
paralyzed after confinement, as a result of the pressure 
to which it has been subjected during the birth. When 
it is filled beyond a certain limit, it may respond to the 
irritation and a little urine be voided, but the bladder 
not be emptied. The nurse can tell by the amount 
passed whether the patient has probably emptied the 
bladder or not. The secretion of urine early in the 
lying-in is very free, hence the quantity passed should 
never be scant. By placing the hand over the lower 
part of the abdomen, the bladder may be felt as a soft 
tumor on one or the other side, above the pubic bone, 



142 OBSTETRIC NURSING. 

the womb being felt as a harder mass pushed to the 
opposite side. 

The catheter should not be used without the physi- 
cian's sanction, but a nurse should never forget to ask 
very particularly about this matter before he leaves the 
house after the delivery. It is generally undesirable to 
allow a patient to go longer than six hours without 
freely emptying the bladder. As over-distention of the 
bladder prevents proper contractions of the womb, and 
as a relaxed womb is a frequent cause of after-pains, it 
is best to have the bladder quite frequently emptied 
during the first twenty-four hours. Hence, if the 
catheter is permitted to be employed, it may be well to 
use it about three hours after delivery for the first time 
(the physician having used it, if necessary, immediately 
after delivery). Its subsequent use should be limited to 
about once in six hours, unless its more frequent use is 
demanded by the interference with the contractions of 
the womb caused by over-distention of the bladder. 
The patient should be encouraged to make a trial to 
urinate as soon as possible, so' that the use of the 
catheter may be entirely dispensed with. Great care is 
necessary in the use of the catheter: ist, to see that the 
instrument is thoroughly clean and kept clean; 2d, to 
see that none of the vaginal discharges are carried into 
the bladder during its introduction ; 3d, to do no injury 
to the mother's parts or give her needless pain. 

The instrument, a glass catheter, should be thoroughly 
boiled if there is any doubt about its being aseptic. 



MANAGEMENT OF THE LYING-IN. 1 43 

• 

When withdrawing it the outer extremity should be kept 
lowered, so that all the urine remaining may flow out 
from it, and no sediment settle in the closed end to be- 
come a source of contamination at some future time. 
It should then be thoroughly washed in hot water, 
which should be allowed to flow through it from the 
inner toward the outer extremity, carrying out any sedi- 
ment from the urine, and it may be kept during the 
intervals of its use in an antiseptic solution — a two per 
cent, solution of creolin, carbolic acid, or lysol. To 
prevent the carrying of the vaginal discharges into the 
urethra the parts should be carefully washed off with an 
antiseptic solution, either by irrigation or by means of a 
soft cloth, before the insertion of the catheter. 

Some patients object to the use of the catheter by 
sight, because of the exposure which it entails. We 
give, therefore, the method of its employment by touch, 
— although its use by sight is greatly to be preferred \ as 
subjecting the patient to less danger from the intro- 
duction of discharges into the urethra. 

Passage of Catheter by Touch. — The index finger 
of the nurse's right hand (which should each time be 
thoroughly cleansed in an antiseptic solution) should be 
slipped into the vagina as far as the second joint, and 
made to follow the anterior vaginal wall down in the 
median line to the vaginal entrance, when a little elevation 
of the surface will be felt, immediately above which the 
orifice of the urethra is to be found. If the finger be 
held with its palmar surface upward and resting lightly 



144 OBSTETRIC NURSING. 

• 

upon this elevation, the finger being held horizontally, 
a glass catheter slipped along it will enter the small 
orifice of the urethra. Should the extremity of the 
catheter seem to meet with any obstruction after its 
entrance into the urethra, a slight withdrawal and rota- 
tion of the instrument will generally carry it in. The 
use of the catheter need not involve the slightest ex- 
posure of the patient. A cultivated touch will enable 
a nurse to do better than by sight in its use. Hence, it 
may all be done under cover. 

Difficult Micturition. — For the first twenty-four to 
forty-eight hours after delivery, particularly if the labor 
has been a difficult one, there is a considerable swelling 
of the parts, which offers a'mechanical hindrance both 
to voluntary urination and the passage of the catheter. 
Great gentleness is therefore required in the necessary 
manipulations. This swelling in an ordinary case should 
disappear at the end of twenty-four to forty-eight hours. 
Should the inability to urinate persist after this, it is in 
all probability due to the condition of paralysis before 
referred to. Especial medication by the physician, as 
the use of muscle and nerve tonics, fomentation over the 
lower part of the abdomen and external generative 
organs, hot water in a bed-pan, placed beneath the 
patient's hips, may serve to stimulate voluntary urina- 
tion. The attempt to induce this should be made each 
time before a resort to the catheter, as the constant use 
of the latter will only keep up the difficulty. 

Constipation. — Constipation due to paralysis of the 



MANAGEMENT OF THE LYING-IN. 1 45 

bowels caused by the pressure of the gravid womb upon 
the bowels is very marked during the lying-in. 

It is desirable to have the bowels moved by injection 
before the end of the first twenty-four hours, and, 
thereafter, to secure a daily movement by such means 
as may be recommended by the physician in attendance. 
Regulation of the food will do much to correct the 
habit of constipation, as a laxative diet composed 
mainly of brown bread, oatmeal gruel, prunes, etc. An 
occasional enema of warm soapsuds may be needed, or 
from a teaspoonful to a tablespoonful of glycerin may 
be injected into the lower bowel, or a glycerin or gluten 
suppository be given. If these means do not suffice, 
some medication may be needed. The laxative chosen 
by the physician will depend upon the condition of the 
breasts, as well as its liability to affect the milk. 

Should the breasts be over-distended, a saline laxative 
will be preferred. Thus, two teaspoonfuls of Rochelle 
salts in a half-tumblerful of cold water may be given, an 
additional tumblerful of pure water being taken after it. 
Sulphate of magnesia or Epsom salts may be used in 
the same way, or a teaspoonful of cream of tartar may 
betaken night and morning in a cup of sweetened water. 

When the secretion of milk is scanty, a vegetable lax- 
ative is to be preferred, as rhubarb, aloes, or cascara 
sagrada. 

At times there is such impaction of the contents of 
the lower bowel that an oil injection will be needed. A 

gill of cotton-seed oil may be introduced into the lower 

10 



I46 OBSTETRIC NURSING. 

bowel and retained for three or four hours, after which 
a small soap and water injection will lead to a thorough 
evacuation of the bowel. 

The Care of the Nipples and Breasts is very im- 
portant. If this matter has received proper attention 
during the pregnancy, there will be comparatively little 
trouble during the lying-in. It is important to keep the 
nipples clean. Milk should not be allowed to collect 
about them, hence immediately after nursing, while they 
are swollen and soft, they should be washed ; a soft 
piece of linen may be used and cold water, or a saturated 
solution of boric acid, after which they may be dried 
with a soft cloth. This should be repeated after every 
nursing. 

If the skin of the nipple be unusually thin, it is best to 
avoid having the baby pull directly upon the nipple until 
the milk flows freely, hence a nipple shield should be 
used, at least for the first two or three days, if not 
longer. 

Should the nipple become sore at any time, the nipple 
shield should again be resorted to and used until the 
sore is healed. 

Some application, as a ten per cent, solution of tannic 
acid in tincture of myrrh, balsam of Peru, or a weak 
solution of nitrate of silver, according to the order of the 
physician, may be painted with a camel's-hair brush over 
the cracks in the nipple while it is soft and swollen, im- 
mediately after nursing. A very healing application 
consists of a paste made of equal parts of bismuth sub- 



MANAGEMENT OF THE LYING-IN. 



147 



nitrate and castor oil. This can be kept constantly 
applied in the intervals of nursing. This may be wiped 
off when the time for nursing arrives, but need not be 
entirely removed, as it cannot hurt the baby. This paste 
or the application of a little oil or cold cream to tender 
nipples will often prevent their cracking. 

For any nipple shield to work perfectly it must fit 
tightly, hence an entire rubber shield is not so good as 
some others. Some shields are 
made of part metal and part rub- 
ber, others part rubber and part 
glass. The cheapest are the or- 
dinary glass shields with rubber 
nipples. They cost about fifteen 
cents and are quite as good as 
those that are higher priced. 

A shield is not good if it allows 
the nipple to be drawn out too far. 
In the intervals of nursing the rub- 
ber nipple should be kept in cold 

water after having been turned inside out and thoroughly 
cleansed with a brush. 

Nipple protectors are worn only in the intervals of nurs- 
ing, or during pregnancy, for shaping the nipple.* These 
may be made of lead, glass, or wood. Leaden protec- 
tors keep the nipples soft in the intervals of nursing, 
and have a healing effect upon the abrasions and cracks 




Fig. 21. — Nipple /Shield. 



See Fig. 6, page 44. 



I48 OBSTETRIC NURSING. 

of a tender nipple. Unless care be taken, however, to 
cleanse the nipple thoroughly before the baby nurses, 
there is danger of lead-poisoning. Nipple protectors of 
glass and wood, being open at the top, are intended 
more to keep the clothing of the patient off the tender 
nipple.* The nipple may, in addition, be kept moist in 
the intervals of nursing by the application over it of a 





Cone-shaped. Hollow. 




Mushroom-shaped. .Depressed. 

Fig. 22. 



piece of absorbent cotton saturated with a mixture ol 
one part glycerin to two parts water. The oily prepar- 
ations are to be preferred. 

Shape of Nipples. — Nipples vary much in shape — 



* There is a form of nipple protector made of glass which also acts as 
a reservoir to catch the overflow of milk in cases where it flows involun- 
tarily from the nipple. This is useful in preventing the constant wetting 
of the patient's clothing. 



MANAGEMENT OF THE LYING-IN. 1 49 

thus they may be cone-shaped, hollow, mushroom- 
shaped, and depressed. 

The cone-shaped nipple is the best, as it can be readily 
seized by the child's mouth, and the pressure of the 
baby lips does not constrict the nipple at its base, so as 
to prevent the free escape of milk from the mouths of 
the milk ducts which open at the top of the nipple. The 
mushroom-shaped nipple has so narrow a base that the 
free flow of milk may be thus prevented. 

The hollow nipple is apt to get sore from two causes : 
first, by the forcible suction made by the child in empty- 
ing the breast; second, by the accumulation of milk in 
the depressed portion of the apex. 

The depressed nipple differs from the last class in the 
fact that there is no elevation of the nipple above the 
surface of the breast, but where the nipple should be 
there is a corresponding depression. Very little may be 
done for such a nipple, and all efforts to make a nipple 
by drawing it out must generally be abandoned, as they 
simply irritate the tender skin. 

Bandaging of Breasts. — It is best when nipples of 
this class exist to abandon the idea of nursing the child, 
and prevent the accumulation of milk in the breasts by 
bandaging. This should also be done where there is a 
previous history of breast abscess — the breast affected 
being thus bandaged to prevent the attempt at secretion 
by the gland. 

The firmest bandage is the figure-of-eight of the breasts, 
which may be applied to one or both of the breasts 



ISO 



OBSTETRIC NURSING. 



according to need. If it cannot be used, the wide, 
straight bandage, similar to an abdominal bandage, 
may be employed, or the straight bandage with straps 
to fasten it over the shoulders, according to the pattern 
used by Dr. Garrigues, of New York. Were the milk 




Fig. 23.— Figure-of-eight of One Breast. 



permitted to accumulate in the breast, and there be no 
ready outlet for it, " caked breast " would be apt to ensue. 
" Caked Breast" is caused by a collection of milk in 
one or the other part of the breast, due to blocking up 
of a milk-duct. The indications for its relief are to empty 



MANAGEMENT OF THE LYING-IN. 



151 




Fig. 24.— Figure-of-eight of Both Breasts. 





Fig. 25.— Garrigues' Breast Bandages. 



Is2 



OBSTETRIC NURSING. 



the breast. The milk may be drawn out by a baby if 
there be a proper nipple, or by the use of the breast- 
pump. 

The breast may be gently rubbed with warm oil and 
stroked from the base toward the nipple to aid in carrying 
the milk toward the mouths of the milk-ducts. Camphor 
liniment is sometimes used as an inunction, alone or 
combined with laudanum; but unless it is the intention 
to help to dry up the milk, camphor should be avoided. 




Fig. 26.— Breast-Pump. 



The use of fomentations before rubbing greatly helps 
to soften up the breast. By fomentations is meant the 
application of flannels wrung out in hot water, constantly 
changed as they cool. These applications should be 
continued for fifteen to twenty minutes at a time. After 
their use if the baby be put to the breast or the breast- 
pump be used, the milk will generally flow quite freely. 

Breast-Pumps. — Those breast-pumps are the best 
which depend for suction on the power of the mouth. 



MANAGEMENT OF THE LYING-IN. I 53 

The Phoenix breast-pump is the one generally preferred. 

They may be used by the nurse, or a patient may use 
such a pump herself should a nurse not be present. 
Hand-pumps are not good, as too much force is apt to 
be used in making suction — the nipple may thus be torn 
off. Where a breast-pump cannot be had, a simple con- 
trivance may be resorted to for emptying the breasts 
which is often very effective. A bottle filled with very hot 
water may be emptied of its contents, and while still hot 
the mouth of the bottle closely applied over the nipple. 
As the bottle cools, the nipple is drawn up into the neck 
of the bottle, and the flow of milk induced. 

Pendulous Breasts. — When the breasts are pendu- 
lous, handkerchief bandages, properly applied, make a 
good support. 

Their application is as follows : " The base of the 
handkerchief, folded as a triangle, should be placed 
obliquely across the chest and under one breast, with the 
apex or summit of the triangle over the corresponding 
shoulder ; one angle is carried over the opposite shoulder, 
the other under the axilla, or armpit, of the same side. 
These ends should be tied on the back of the shoulder, 
and the apex of the triangle pinned to them." (Smith.) 

Should both breasts need support, a similar bandage 
may be applied to the other breast. To prevent the 
base of one or both of these bandages from slipping up, 
the ordinary handkerchief bandage has been modified 
in the Woman's Hospital by the addition of a belt 
around the waist, of a strip of muslin or ordinary roller 



154 



OBSTETRIC NURSING. 



bandage, to which the base of the bandage may be fast- 
ened by safety-pins. 

A simple straight bandage, with a compress to lift the 
outer, pendulous portion of each breast, is sometimes 
used, darts being employed to shape it properly to the 




Fig. 27. — Handkerchief Bandage for Breast. 



person. This makes a firmer support than the handker- 
chief bandage. It should be made of unbleached mus- 
lin or some firm material. 

Another bandage, which has the advantage of not re- 
quiring to be removed when the baby nurses, is the 



MANAGEMENT OF THE LYING-IN. 



155 



double-Y bandage, used in the Boston Lying-in Hospital. 
The manner of putting it on is thus described by Dr. 
Worcester: " A single T-bandage is first made by folding 




Fig. 28. — Worcester's Y-Bandage. 

The upper figure shows the double-Y breast bandage in position ; the lower left- 
hand figure shows how the bandage is made. The third figure shows how 
the double-Y bandage is completed by fastening the arms of the Y to the tail- 
piece on the patient's opposite side. 



a napkin lengthwise so that for an average sized patient 
it shall be 32 inches long by 3 inches wide. At the middle 
of this, and at right angles to it, is pinned, just between 



i 5 6 



OBSTETRIC NURSING. 



its folds, a napkin of the same size, similarly folded. 
This T-bandage is next made into a Y-bandage, by 
making a diagonal fold in the middle of the cross-piece 
and fastening the corners of the plait with safety-pins 
on the outside. The bandage is now ready to put on. 
The tail-piece is passed under the woman's back, snug 
up to her armpits, so that the fork of the Y just clears 
one nipple when that breast is held upward and inward 
on the chest. The tail-piece on the other side is carried 
up on the chest directly over the breast. The arms of 
the Y are then brought over the chest, one above and 
the other below the breasts, and their ends pinned to 
the tail-piece, so as to hold both breasts in similar posi- 
tion. A compress of soft linen 
may be placed between the band- 
age and the outside of the breasts, 
and also between the breasts, to 
prevent their chafing. To keep 
the bandage from slipping down 
straps of muslin may be passed 
over the shoulders and pinned 
back and front. To keep it from 
slipping up, it may be fastened to 
the abdominal bandage." The bandages referred to are 
very useful while the patient is in bed, but when she 
begins to sit up and wear ordinary clothing they will be 
found to be cumbersome. Some such breast support 
as is shown in Fig. 29 may then be found very useful. 
Gathered Breasts. — There is nothing in the care of 




Fig. 29. — Obstetrical 
Breast Support, with 
Knitted Bosoms. 



MANAGEMENT OF THE LYING-IN. 1 57 

a lying-in patient for which a nurse receives more blame 
than in the occurrence of gathered breasts. Abscesses 
will sometimes come, however, in spite of all precau- 
tions, even before confinement. Extreme watchfulness 
and a prompt reporting of any symptoms of beginning 
trouble, as chilliness, hardness of the breasts, sore nip- 
ples, etc., will do much to avert them. It must never be 
forgotten that sore nipples, by offering an open surface 
upon the mother's body, may become avenues of septic 
infection. Dirty hands or dirty garments touching these 
surfaces or poison from the baby's mouth may thus 
enter the mother's system. One of the most serious 
forms of inflammation of the breast may thus result 
from blood-poisoning. If the breast has once gathered, 
there will be a tendency for it to gather again. Should 
an abscess threaten by beginning inflammation of the 
breast, the treatment will, of course, be directed by the 
physician. What milk is in the breast must be drawn 
out, and some means used to prevent further secretion. 
The use of an ice-bag to arrest tendency to inflamma- 
tory involvement is advised by some, the breast being 
at the same time elevated and compressed by a bandage. 
Belladonna breast plasters were at one time much used, 
the circular breast plasters being obtained at any drug 
store. The belladonna ointment spread on patent lint, 
shaped to the breast, is preferred by some physicians. 
Simple compression of the breast by a firm bandage is 
generally sufficient, without the aid of other measures, in 



I58 OBSTETRIC NURSING. 

the checking of the secretion after the breast has been 
emptied. 

Should the breast gather, lancing is inevitable, and 
the sooner the better, so that a nurse should keep the 
physician carefully informed as to the condition of the 
breast. Flaxseed poultices or, far better, antiseptic 
poultices (consisting of several layers of sterilized gauze 
wrung out of hot sterile water and covered by gutta- 
percha tissue), may need to be applied for a time, both 
before and after lancing. These poultices, to do any 
good, should be applied as hot as possible. The nurse 
can test the heat of the poultice by laying her cheek 
against it. If she can bear this application without find- 
ing it too hot, the patient will also probably be able to 
bear it. If the poultice be made of flannel it will not 
lose its heat as quickly as when made of muslin. The 
poultices will require changing about once in two hours, 
or often enough to keep them warm ; and should be 
kept up until the abscesses point and are evacuated. 
The nurse should encourage the patient to have an 
abscess lanced, and should have prepared, at the time of 
the operation, the antiseptic solution preferred for the 
physician's hands and for washing out the abscess cavity, 
a syringe, if possible, a pus-pan having a concave side to 
fit closely under the breast, some charpie (linen threads 
arranged in bundles for packing abscess cavities), soft 
towels, and some absorbent cotton to be used in place 
of sponges for cleansing the breast. Before the opera- 



MANAGEMENT OF THE LYING-IN. 1 59 

tion, the breast should be washed off with an antiseptic 
solution. Between the applications of the different poul- 
tices the breast should be similarly washed off by the 
nurse. The physician will probably desire to wash out 
the abscess cavity daily so long as the discharge of pus 
continues, in which case the nurse should have every- 
thing in readiness at the time of his expected visit. 

Galactorrhea. — Sometimes milk runs constantly from 
the breasts. Much may be done to prevent this by 
regular nursing. If it persists, the amount of liquid in 
the food should be restricted. Sometimes the milk runs 
from the opposite breast while the baby is nursing at 
one. There is no way to prevent this. Some mothers 
collect it as it drops in a small bottle or cup and feed it 
to the baby. 

Insufficient Milk. — If the mother has only sufficient 
milk for half the day, the baby had better be artificially 
fed by day, the breast milk being reserved for the night, 
as giving less trouble when the care of the child de- 
volves upon her. 

After-pains are the same as labor-pains, being caused 
by contractions of the womb. They are called after- 
pains because they occur after confinement. A woman, 
after the birth of her first baby, seldom has after-pains. 
They may occur with varying severity in women who 
have previously borne children. If the bladder and the 
bowels are properly attended to, and the womb kept well 
contracted, the patient is not likely to suffer much from 
after-pains. 



l6o OBSTETRIC NURSING. 

These pains seldom last over the second day. Should 
they do so, it is probable that the patient is threatened 
with some inflammation. 

The occurrence of after-pains should, of course, be at 
once reported to the doctor, and such measures for relief 
carried out as he may suggest. 

The womb will be found to be in two entirely different 
conditions with the occurrence of these pains. Hence, 
we divide the pains into two classes, the " expulsive " 
and the " spasmodic" or " neuralgic!' 

With expulsive after-pains the womb, as it is felt 
through the abdominal walls, will be found to be large 
and soft, and the patient will often pass clots. The 
bladder will be frequently found to be over-full and the 
womb pushed high up or to one side. The indications 
are to empty the bladder and to secure good contractions 
of the womb. After the bladder is emptied the pain 
maybe relieved by the application of a hot poultice over 
the lower part of the abdomen, and simple fluid extract 
of ergot may be given, if desired, by the physician (j/ 2 
teaspoonful every three hours), until the womb is well 
contracted. A nurse should never give any medicine 
without the direction of the physician. Before entire 
relief is obtained it may be necessary for the physician 
to break down and wash out the clots within the womb. 

Intra-uterine Injection. — The nurse should slip 
drawers and stockings on the patient in preparation for 
this operation, as she may need to lie across the bed 
with her hips drawn to its edge. A bed-pan, syringe, 



MANAGEMENT OF THE LYING-IN. l6l 

antiseptic solutions, receptacle for waste water, and 
rubber protective for bed and floor should be prepared. 

When spasmodic after-pains occur, the womb is felt in 
the lower part of the abdomen as a firm, round ball of 
stony hardness. This is caused by a spasm of the mus- 
cle fibers in the womb. The remedies which would help 
expulsive pains would only aggravate this condition. 
Something must be employed which will quickly relax 
the spasm. The most efficient agent is chloroform lini- 
ment, which may be applied on flannel over the lower 
part of the abdomen. The acute counter-irritation thus 
produced will give relief. Should the spasm be very 
severe, the physician may apply pure chloroform sprin- 
kled on blotting-paper, for a few seconds, over the lower 
part of the abdomen until it well reddens the skin. 
Should no chloroform liniment be at hand, a warm flax- 
seed poultice may help to some extent, though not so 
efficient, as a rule. 

A Careful Report should be kept by the nurse, from 
which the physician can learn all that has transpired in 
the intervals between his visits. 

Sheets of paper, ruled and having headings, as in the 
accompanying diagram, are used in the Woman's Hos- 
pital. 

Observation of Symptoms. — The occurrence of 

pain, any complaint of chilliness or a decided chill, rise 

of temperature, rapid pulse, sleeplessness, headache, 

want of appetite, etc., should be carefully noted and 

brought to the physician's attention, 
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l62 



OBSTETRIC NURSING. 



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MANAGEMENT OF THE LYING-IN. 1 63 

For the first week or ten days it is well to take the 
temperature and pulse in the morning, at noon, and in 
the evening; after which, if the patient is doing well, 
the morning and evening temperature and pulse will be 
sufficient. 

Should the slightest complaint of chilliness be made, 
the nurse should place extra covers around the patient, 
hot-water bottles, if necessary, to warm her up, and at 
the same time give her a warm drink, as a cup of hot 
tea, or even hot water. 

The temperature should always be taken after a com- 
plaint of chilliness, and taken quite frequently, as every 
hour or two, when, if it be found to be rising, a note 
should at once be sent to the physician, who may want, 
under the circumstances, to see the patient at once or to 
institute some new line of treatment. Pain may be tem- 
porarily relieved by the application of a hot flaxseed 
poultice. Grave inflammatory and septic troubles are 
ushered in by such symptoms as the above, hence no 
time should be lost in notifying the physician of their 
occurrence. 

Puerperal Fever. — The use of blisters, poultices 
packs, vaginal injections, and medicinal remedies re- 
quired in the treatment of the various forms of " puer- 
peral fever " must, of course, be in exact accordance with 
the physician's directions. 

Such troubles are generally septic — that is, arise 
from blood-poisoning; and one very important duty 
of the nurse will be to see that the patient takes 



164 OBSTETRIC NURSING. 

sufficient nourishment to combat the poison in the 
blood. 

Stimulants should never be given without a physician's 
advice, but when ordered great care should be exercised 
in their faithful administration. Egg-nog, milk-punch, 
whiskey-punch, wine-whey, milk in the various liquid 
and semi-liquid preparations, beef-tea, broths, etc., will 
be called for. The nurse should be ready with devices 
to tempt her patient to eat, and thus give the most im- 
portant aid to the arrest of the disease. The support of 
the strength, with extreme cleanliness and thorough 
antisepsis, will do much to arrest the course of the ter- 
rible maladies due to blood-poisoning. 

Puerperal Ulcers. — The existence of any sores about 
the vulva or vagina, when discovered by the nurse, 
should at once be reported to the doctor. These are 
especially dangerous when they take on a grayish sur- 
face, as this indicates that they have already become in- 
fected by poison. If the disease is not arrested here, 
the whole system may be involved. 

Milk Leg. — A swelling of one or both legs some- 
times comes on after delivery. It is ushered in by acute 
pain and lines of redness accompanying the swelling — 
the vessels of the groin, under the knee, or in the leg, 
will often feel like cords. This is due to an inflamma- 
tion involving the veins. Sometimes blood clots form 
in the veins, which may be dislodged and carried to the 
heart and lungs, when they are the source of the 
gravest danger. Sometimes abscesses form in the leg. 



MANAGEMENT OF THE LYING-IN. 1 65 

The great danger of clots being carried in the blood cur- 
rent makes absolute quiet imperative. The patient 
should lie flat on her back, and the limb be elevated on 
pillows or on an inclined plane such as the fracture-box 
used in certain fractures of the lower extremity. 

The application of some soothing ointment, as iodin 
and belladonna ointment in equal parts, over the cord- 
like veins, a hot flaxseed poultice being kept over the 
ointment, will help to relieve pain and diminish inflam- 
mation. The whole limb should be kept warm by a 
wrapping of cotton batting. The limb is most comfort- 
able when slightly bent at the knee-joint. Should the 
weight of the bed-clothing cause pain, a cradle may be 
made of barrel hoops for lifting them off the limb. The 
cradle is also very useful in cases of peritonitis when the 
same difficulty exists. 

Bed-sores. — Lying-in women should not be subject 
to bed-sores, but should some complication occur, as in 
some form of blood-poisoning, or should some other 
disease attack the patient during this time, necessitating 
long lying, special care is necessary to prevent bed-sores. 
The parts of the body subjected to most pressure should 
be kept thoroughly dry and rubbed with alcohol and 
alum (a saturated solution) once or twice daily. A little 
cosmolin may then be rubbed into the skin, or some 
drying powder, as zinc or starch, may be used. When 
a sore occurs it must be dressed, according to the 
physician's order, with zinc ointment or cosmolin. 
All pressure should be kept off it, if possible, by 



l66 OBSTETRIC NURSING. 

the adjustment of pads and pillows or a rubber-ring 
cushion. 

Puerperal Mania is a form of mental trouble which 
may affect lying-in patients, particularly when they are 
exhausted from any cause, whether it be mental worry 
or physical ill-health. In true mania the patient may be 
violent and very difficult to control. In the melancholic 
type of this trouble she is exceedingly depressed, dis- 
trusts her best friends, and cannot be roused to take an 
interest in her surroundings. 

As soon as it is noticed that the patient's mind is not 
well balanced, the baby should be removed from the room, 
only being brought to the mother when asked for. 
The nurse should then keep a close watch over it, as 
one of the chief symptoms of this trouble is a strong 
aversion to the baby and desire to destroy it. 

It should never be forgotten that an insane patient 
should not be left alone for a moment. The insane are 
very cunning, and though apparently asleep maybe but 
watching their opportunity to indulge in some mad 
freak, as jumping out of the window, dashing down the 
stairway and out of doors, etc. The windows, there- 
fore, should be in some way protected. A nail or screw 
may be driven into the window-casing so as to prevent 
the raising of the sash, except so far as ventilation re- 
quires. The door had best be kept locked, the nurse 
keeping the key. 

The treatment will mainly consist in keeping up the 
nourishment and in kind, gentle, tactful management. 



MANAGEMENT OF THE LYING-IN. 1 67 

The patient should be made to interest herself in outside 
things, by the judicious turn given to the conversation 
by the nurse, by engagement in some kind of fancy- 
work, or in games which will help to divert the mind. 

She should not be crossed, neither should she be de- 
ceived. The nurse should so manage her as to inspire 
a thorough confidence and liking toward her on the part 
of the patient. If she has not these, she had best give 
up the case, as she will not be able to help the patient. 

Should the patient absolutely refuse to eat, the physi- 
cian may direct the nurse to introduce the food into the 
stomach by means of a rubber tube passed through the 
nostril and down the esophagus, or gullet. Care should 
be taken to do no injury in the introduction of this 
tube, which should be well greased with cosmolin and 
made to follow closely the direction of the passage, it is 
made to enter. A funnel is then connected with the 
outer extremity, through which the milk or broth, etc., 
may be poured into the stomach. 

Should the patient be exceedingly restless, and dis- 
posed to jump out of bed, to her own detriment, she 
may be fastened into the bed by means of a sheet, 
doubled lengthwise, placed over the middle portion of 
the body from the arm-pits to below the knees and car- 
ried under the bed, to be fastened either beneath the bed 
or to one side of it. The feet may be bound together 
loosely at the ankles by a piece of roller bandage and 
fastened to the footboard of the bed. The hands may 
be bandaged together (being placed the one on top of 



1 68 OBSTETRIC NURSING. 

the other) by means of a roller bandage, though this is 
not necessary except when they are used to do herself 
injury. When patients are so violent as to need such 
restriction, however, it is better to have them removed to 
some institution for the insane as soon as possible, where 
there is better provision made for their management. 
The use of sedative remedies by the physician will gener- 
ally prevent the necessity for resorting to such extreme 
measures for confining the patient in ordinary cases. 

Medicines should, of course, never be left in the 
patient's room, even when the nurse is there, unless 
under lock and key. The duration of this malady 
varies from weeks to months, in some cases becoming 
chronic. Convalescence is generally very gradual. 
Patients may have long periods of lucid thought, and 
seem apparently well, only to unexpectedly return to 
their vagaries ; so that the nurse should never relax her 
quiet vigilance while in charge of the case. 

The First Sitting-up. — The old time-honored belief 
that a woman should sit up on the ninth day is subject 
to many exceptions, which should be understood by the 
nurse as well as by the physician. The trtie gage is the 
progress of involution. This may be determined by the 
height of the uterus (which ought to sink behind the 
pubic bone before the patient is allowed to sit up) and 
by the character of the discharges. So long as there 
is any blood in the discharges the patient should not sit 
up, for this is an indication that involution, or the shrink- 
ing of the womb, is not going on properly. This con- 



MANAGEMENT OF THE LYING-IN. 1 69 

dition is known as " sub-involution" and it neglected 
may lead to chronic disease of the womb. The use of 
the recumbent or semi-recumbent posture, frequent hot 
injections given by the nurse, or remedies administered 
by the physician, may be necessary to overcome it. Let 
the patient understand the wisdom of her confinement 
to bed under such circumstances, and she will generally 
yield gracefully to the necessity. The first sitting-up 
should be in bed, the patient's back being supported by 
a bed-rest. Should no bed-rest be found in the house, 
a chair turned upside down, with its back toward the 
patient, over which a pillow is placed, offers a tfery good 
substitute. 

After sitting up in bed for a day or two, from a half- 
hour to an hour if there be no discharge, the patient 
may have her flannel wrapper and stockings and bedroom 
slippers put on, and be allowed to sit up in an easy 
chair. It must be remembered that this is the time 
when the patient will be most susceptible to cold, there- 
fore every precaution must be taken to prevent her ex- 
posure to draughts. Should the patient seem to grow 
tired before the half hour or hour is up, she should be 
put back in bed. The interval for sitting up may be 
gradually increased from day to day, until she is up the 
greater part of the day. No going up and down stairs 
should be permitted until the physician sanctions it, 
which is, in ordinary cases, about the fifth or sixth 
week, when one such journey a day is generally per- 
mitted. 

Order Board. — That there may be no misunderstand- 



170 



OBSTETRIC NURSING. 



ing between physician and nurse, the orders of the phy- 
sician in every case should be immediately set down in 
writing when given, so that by constant reference to 
them the nurse may do her full duty by the patient. It 
is well, for this purpose, to have a piece of paper ruled 
so that at the right side there shall be two columns, one 
headed A. M.,the other P. M. The stated hours for the 
administration of medicine or carrying out of treatment 
may then be placed opposite the special directions for 
each, and a pencil mark be drawn through the figure 
1 representing the hour when the matter has been at- 
tended to. 

An order board, as used in the Woman's Hospital, is 
prepared as follows : — 



Orders for Treatment of Mrs. Richards, Oct. .10, 1 



Full breakfast, dinner, and supper, . . . 
A teaspoonful of medicine (light or dark). 

Sponge bath, 

Lunch of gruel or beef-tea, 

Glass of milk at bedtime, 

To sit up half an hour with bed rest, . . 



A. M. 



6 

6.30 

.10 

9 



P. M. 



12, 6 

I2.3O, 6.3O 



Nurse' s Name. 



A fresh board should be prepared for each day's work. 
In ordinary cases, which run an uneventful course, these 
boards, with the hours crossed off, serve the purpose of 
a report as well. 



CHAPTER XII. 
CARE OF THE NEW-BORN INFANT. 

The mother being made comfortable after her delivery, 
the nurse should turn her attention to the infant. 

First Toilet. — Everything needed for the baby's first 
toilet should be collected and placed conveniently at 
hand, near the register, stove, or open fireplace. 

The nurse should put on a flannel apron orpin a crib- 
blanket or flannel petticoat over her lap. The best bath- 
apron is one consisting of two pieces of flannel fastened 
to the same waistband. The lower piece is the one on 
which the baby lies ; the upper serves as a covering. 
A pitcher of warm water' and one of cold must be 
provided, the baby's bath-tub being placed near them, 
the baby-basket, suit of aired clothing, and jar of 
rendered lard or oil within reach. The nurse should 
pick the baby up with its wraps and place it in 
her lap as she seats herself on a low chair or stool near 
the fireplace. 

The baby will be found to be covered over portions 
of its body by a white, greasy substance, called "vernix 
caseosa," or " cheesy varnish." This substance is found 
in greatest quantity on portions of the body subjected 

171 



172 OBSTETRIC NURSING. 

to friction while in the womb, hence it serves to protect 
the child's skin. 

Some kind of grease is needed for its removal. Ren- 
dered lard and oil are the best. Cosmolin is not so good, 
as it is stiffer than the other two — not so soluble a fat. 
Lanolin is good. All this cheesy substance must come 
away with the first washing, as, if left, it irritates the skin 
and produces sores. The most difficult parts of the body 
to cleanse are the folds or creases. The nurse should take 
a piece of lard about the size of a walnut, rub it over the 
palms of both her hands, and then, taking the child's 
head between her hands, rub the grease thoroughly in, 
giving especial attention to the ears. A second piece 
of lard, of the same size, will be needed for the neck, 
shoulders, arms, chest, and back ; a third piece for the 
groin, external generative organs, and lower limbs. The 
creases and folds about the generative organs, especially 
of a girl baby, need very careful cleansing. When the 
baby has been thus thoroughly gone over, the nurse 
should take the corner of a dry sheet and rub off the 
grease. Many physicians prefer not having the baby 
bathed after this greasing. It may then be dressed and 
laid in its crib. 

Should the bath be preferred, the nurse should wrap 
the baby up in her flannel apron, draw the bath-tub 
toward her, and prepare the bath, filling the bath-tub 
about one-third full of warm water at a temperature ot 
ioo° F., tested by the thermometer. A wall-thermom- 
eter, costing fifteen cents, may be obtained at any drug- 



CARE OF THE NEW-BORN INFANT. 1 73 

store for the purpose*. The baby is then placed in the 
tub, its entire body, excepting its head, being immersed 
for a moment or two beneath the water. The nurse 
should keep the baby from slipping from her grasp by 
allowing its head to rest against her left wrist and hand, 
while the fingers of the same hand obtain a secure grasp 
under the child's left arm-pit. After the dip, the child 
is lifted out on to the nurse's lap again, where a soft, 
warm towel should have been spread for its reception. 
In this it should be wrapped and thoroughly dried. 
Great care must be taken to see that the arm-pits, groins, 
and other parts of the body where creases exist are en- 
tirely free from moisture. After the first bath, the child 
receives, as a rule, but a sponge-bath daily until the 
cord drops, when the daily plunge-bath may be given. 
The baby should always be thoroughly washed with 
simple warm water over the parts of the body soiled 
every time the napkin needs to be changed. Soap does 
not need to be used. Its frequent use would irritate the 
skin, and the parts can be perfectly cleansed without it. 
The use of powder in the folds and creases of the 
body is not essential. The main object is to keep rub- 
bing surfaces dry, and should the nurse properly attend 
to this duty after the bath, this, with the use of flannel 
next the baby's skin, ought to be sufficient to effect the 
purpose. Should a powder be desired, some very fine, 
unirritating powder, such as plain talcum, might be used. 
Many of the scented powders contain substances which 
are irritating to the skin. 



174 OBSTETRIC NURSING. 

Dressing the Cord. — After the* baby has been dried, 
the stump of the cord or navel-string should be attended 
to. Make a loop of the stump, doubling it back upon 
itself, and tying it tightly by means of the ends of the 
bobbin left from the first ligature. Slit up a square of 
soft sterilized linen or gauze to its center. Put this 
around the cord, which is slipped through the slit (the 
slit looks upward toward the child's head), fold over the 
ends, and turn the whole upon the left side. The 
gauze may be used in the form of a narrow strip and 
twisted around the cord so as to thoroughly infold it. 
Some physicians will direct that no dressing be placed 
around the cord. In fact, sometimes there is no ligature 
placed around it, but it is simply well stripped of the 
blood and jelly-like substance which help to compose it, 
and thus allowed to dry. 

The placing of the loop of cord with its dressings on 
the left side of the child's body is to avoid pressure upon 
the liver, which is larger than any other organ in the 
infant's body at birth, so large, in fact, as to extend quite 
down to the navel. The abdominal bandage is put on 
over the dressing to hold the latter in place. 

A drying powder, consisting of one part salicylic acid 
and five parts starch, is an antiseptic application thought 
by some to hasten the drying of the cord. Boric acid 
is sometimes used in the same way. 

A clear substance exudes from the cord as it shrinks 
which wets the dressings, so that it is necessary to 
change them quite often the first day or two. The ab- 



CARE OF THE NEW-BORN INFANT. 1 75 

domen around the navel should be carefully washed with 
a boric acid solution every time the dressing is changed. 
A cord kept dry by the frequent change of dressings 
will have no odor about it, and will drop, on an average, 
by the fifth day. The base from which the cord dropped 
may continue moist for a few days, and is best dressed 
by placing a small compress of antiseptic linen or gauze 
over it. To prevent this from sticking, a little boric acid 
powder may be dusted over the moist surface. The 
navel-dressing is kept in place by the application of the 
flannel binder, which should be carefully adjusted, so as 
not to compress the abdomen too tightly. After the 
bandage is fastened, the nurse's hand, used flatwise, 
should be easily slipped in between the bandage and the 
baby's skin. Should safety-pins be used in fastening the 
bandage, they should be placed in front and not at the 
back, or they may cause the baby discomfort in lying. 
The bandage fastened by the tapes, which is simply 
wound around the body, is safer on this account. 

Great importance should be given to the proper care 
of the navel, as it offers an open surface on the child's 
body through which poisonous matter may be taken into 
the blood, causing " infantile sepsis," or the blood-poison- 
ing of infants. 

Meconium. — Before the dressing of the cord, a napkin 
should have been laid beneath the hips of the infant, 
as there is very apt to be a free discharge of a dark, 
greenish matter from the bowels shortly after the birth. 
This is known as " meconium." It should always come 



I76 OBSTETRIC NURSING. 

away within the first twenty-four hours after birth, and 
may continue to come at intervals for three or four days. 
When it does not come away freely the baby may suffer 
considerable pain. A soap suppository or a small injec- 
tion of warm water will bring about relief, causing an 
evacuation of the bowels. 

This substance is very difficult to wash out of napkins, 
hence it is a good plan to have a soft piece of old 
muslin placed inside the napkin to catch the discharge. 
This may be burned when removed. 

Cleansing. — The baby should be washed every time 
the napkin needs to be changed, even if it is only wet. 
Warm water should be used. A napkin should never 
be used twice without washing. The habit of hanging 
up a napkin wet with urine, allowing it to dry, and using 
it again, is not only filthy, but unsafe, as it renders the 
napkin irritating to the skin and a source of possible 
septic infection. For the same reason a napkin should 
be changed as soon as it is wet or soiled. Though the 
work may be irksome, a nurse should not weary of it; 
for it is only by eternal vigilance that the child can be 
kept in good condition. 

Clothing. — After the application of the binder and 
napkin, the baby's under-vest, or little, long-sleeved, 
high-necked flannel shirt, should be put on. This 
should be fastened in front by safety-pins, or small, flat 
buttons or tapes. 

If the shirt is too large, folds should be made at the 
sides to make it fit better; never in the back, because 



CARE OF THE NEW-BORN INFANT. I 77 

of the ridge this would produce under the surface upon 
which the baby lies. 

The socks come next, and then the flannel slip, con- 
stituting the only other garment the baby needs. The 
petticoat with slip, or Gertrude suit, may be used instead, 
if desired. 

Eyes and Mouth. — The eyes and mouth should each 
be washed out with a separate soft piece of linen dipped 
in warm water. 

The Baby's Hair, if it has any, may be brushed with 
a soft baby-brush. No comb should be used, as the 
scalp is too tender. 

After-care. — The baby should then be placed in its 
crib, on its right side, and warmly covered. The weaker 
the baby is, the warmer it will need to be kept. Stone 
jars, when filled with hot water, are nice for this purpose 
placed around the child, but care should be exercised 
not to let these bottles be placed so near as to cause a 
burn. 

In another chapter we will consider the care of pre- 
mature infants. 

The weighing of the baby devolves ofi;en upon the 
nurse. A steelyard being provided, the nurse may 
place the nude child in a napkin, tied or pinned securely 
at the corners. This napkin may be swung on to the 
hook of the steelyard as it is held up. The pointer will 
then indicate the number of pounds weight. The aver- 
age weight of a new-born baby is 3250 grams (about 
seven pounds), 



i 7 8 



OBSTETRIC NURSING. 



In the Woman's Hospital the ordinary grocer's pan- 
scales are used, the weights being represented in grams. 
The daily weight is taken and recorded on a card which 
hangs by a ribbon or string to the baby's crib, so that its 
daily condition may be carefully watched. For a com- 
parison of the approximate weights in the metric and 
avoirdupois scales, I append the following table of 
equivalents : — 



Relation of Avoirdupois to Metric Weights. 

GRAMS. i AVOIRDUPOIS GRAMS. 



AVOIRDUPOIS 
POUNDS. 

i 453-592 

2 907.18 

3 1360.78 

4 1814.37 

5 2267.96 



AVOIRDUPOIS 
POUNDS. 

6 2721.55 

7 3175 H 

8 3628.74 

9 • 4082 33 

i° 4535 92 



For the first three or four days a baby will lose 
weight, as it does not take in enough nourishment to 
make up for the loss it sustains by the newly acquired 
activity of bowels, bladder, and skin. At the end of the 
first week the baby should weigh about what it did at 
the birth. After that it should gain, on an average, 
thirty grams a day (about one ounce) for the first two 
months of its life. 

A Sponge bath is sometimes given the baby at the 
close of the day, when its clothing is changed for the 
night; but this is not necessary, if it has been properly 
attended to when the napkins have been changed. The 
fresh clothing at night is always essential. 

The Baby's Crib should have no rockers. All un- 



CARE OF THE NEW-BORN INFANT. 



179 



necessary swinging, rocking, and jolting of babies only 
serves to make them nervous and more troublesome to 
take care of. A convenient and inexpensive crib and 
bath-tub combined, especially for traveling, is described 
in one of the numbers of " Babyland," thus : " The 
frame is made something like a cot-bed. Straight pine 
sticks may be used. The legs, one inch and a half 
square by thirty inches long, are crossed and pivoted in 




Fig. 30. — Home-made Bath-tub and Crib. 



the middle on a center bar. The side bars, one inch by 
two inches, and thirty-six inches long, are securely fast- 
ened to the top of the legs. Smaller bars join the legs 
near the bottom to stiffen the frame. A piece of heavy 
rubber-cloth, one yard and a quarter long and thirty 
inches wide, has an inch-wide hem on each end for a cas- 
ing, and is drawn up to eighteen or nineteen inches with 
heavy braid (a leather strap would probably be better). 



l8o OBSTETRIC NURSING. 

This makes the ends of the tub. Along the side bars of 
the frame are tacked with brass-headed tacks the sides 
of the cloth, the braid (or rubber straps) being securely 
fastened to the ends. A small plait in the cloth at each 
corner, about an inch from the end, gives a fuller shape 
to hold the water (when it is in use as a bath-tub). The 
tub (or crib), when not in use, can be folded and set away 
out of sight, or it may be carried in the bottom of a 
large traveling-trunk when on a journey. The frame 
may be made of walnut or cherry, with turned legs, etc., 
if so desired. A pillow put in the tub makes a comfort- 
able and portable crib for the baby. 

Children should never sleep in the same bed with their 
mothers. It is unsafe because there is danger of their 
being overlaid, and it is unhealthful because of the dis- 
charges, breath, etc., of the mother. 

Tubs for Babies. — Many varieties of tubs are made 
for babies, of tin or agate-ware, or porcelain. A painted 
tin foot-tub serves a good purpose while the child is 
small. These may be placed upon a bath-stand or low 
chair to prevent the necessity of too much stooping on 
the part of the nurse while bathing the baby. 

Training of a Baby. — A baby may be trained to be 
contented and happy as it lies in its crib. If from its 
earliest days it is taken up simply to be fed, and to 
receive the necessary attentions for keeping it clean 
and comfortable, it will not become the little tyrant 
a child develops into when foolishly spoiled by its 
mother. 



CARE OF THE NEW-BORN INFANT. l8l 

Feeding of Infants. — Babies should be fed but once 
in two hours during the day, and every three hoars duri?ig 
the night, unless premature, when they can take less, and 
should be fed every hour. An interval is necessary be- 
tween the feedings in order that the stomach may rest 
and be prepared properly to carry on its work of diges- 
tion. Hence, the habit some mothers have of letting 
babies nurse whenever they cry simply serves to produce 
indigestion, as well as to spoil the child.* 

For its first nursing the baby may be put to the breast 
an hour or two after the labor, if the mother is suffi- 
ciently rested. The nipples should, before each nursing, 
be carefully washed off with a solution of boric acid. The 
early secretion of the breasts, known as " colostrum," 
helps to rid the baby's bowels of their dark, tarry contents, 
as it is laxative. It is important that the breasts should 
be used alternately in feeding the infant, as this allows a 
longer time to elapse for the accumulation of milk. For 
the first day or two the baby needs comparatively little 
food. Should it seem to be hungry, however, and the 
mother unable to satisfy it, a teaspoonful or two of warm 
water or diluted peptonized cow's milk, prepared accord- 
ing to the suggestions to be given later, may be admin- 
istered at regular intervals. 



* It has been observed that when the periods between nursing were short 
the milk was more condensed, a fact which throws light on the dyspeptic 
phenomena occurring in babies who are fed too often. — Rotch. 



1 82 OBSTETRIC NURSING. 

Before and after each feeding, the baby's mouth 
should be carefully washed out with a piece of soft linen 
dipped in warm water or a saturated solution of boric 
acid. This is to prevent the particles of milk remaining 
in the mouth from producing soreness by souring. 

Two or three times daily a baby should be given a 
teaspoonful of cool water to drink, as babies suffer from 
thirst just as their elders do. The water assists, also, 
in keeping the bowels from becoming constipated. The 
water should be boiled and kept in an air-tight flask. 

Insufficient Milk. — Should the mother not have suf- 
ficient milk for her baby, it may have the bottle every 
other time, the additional food being selected with refer- 
ence to the child's age and powers of digestion. 

The Wet-nurse. — When a mother has no milk, the 
best substitute is a good wet-nurse. A wet-nurse should 
always be carefully examined by a physician, that her 
freedom from disease may be fully determined before she 
is employed. She should be between twenty and thirty 
years of age, and have good, not necessarily large, 
breasts, well-shaped nipples, and an abundant supply of 
milk. The condition of her own child should be con- 
sidered, whether it be thriving or sickly, and especially 
whether there be any evidence of special disease. It is 
well, too, to try to get a woman who has had more than 
the one child, as a woman who has borne several chil- 
dren has, by experience, learned to understand and 
manage babies. 



CARE OF THE NEW-BORN INFANT. 1 83 

Lactation. — The first milk that comes in the breast, 
and which appears in any quantity, about the eighth 
month of pregnancy, is called " fore-milk," or " colos- 
trum," from a word which means " glue." It is turbid, 
yellowish, gluey, alkaline in reaction, and sours easily. 
It differs from true milk in having a higher specific 
gravity or weight; it also contains more salts and more 
albumin, and is more difficult to digest. It is laxative 
in its effect upon the baby's bowels. Physicians not 
infrequently examine a specimen of this secretion under 
the microscope, to learn what the prospect is as to the 
mother's nursing the child. If, in the last two months 
of pregnancy, the colostrum is scanty, and under the 
microscope there are but few oil globules, the patient 
will probably have poor milk and scant in quantity. If 
the colostrum is abundant but thin, like gum water, not 
gluey and without yellowish streaks, it is probable that 
the milk will be watery and not nourishing. It may be 
either scanty or abundant. If the colostrum be plentiful, 
with yellowish streaks and full of milk globules, the 
milk will be abundant and good in quality. The secre- 
tion of colostrum may continue from six to eight days. 
If it continues longer, it is a great disadvantage, and 
the mother may have to give up nursing because of 
the child's inability to digest the nourishment thus 
afforded. 

Human milk should have a specific gravity of 1020- 
1034. It is slightly alkaline in reaction; that is, it will 



184 OBSTETRIC NURSING. 

turn red litmus-paper blue, and it contains the following 
ingredients : — 

Water, . . 87-88 

Total solids, 13-12 

Fat, 3-4 

Albuminoids, 1-2 

Sugar, 7.0 

Ash, . . . 0.2 

—Rotch* 

It differs from cow's milk in having a higher specific 
gravity, more solids, less water, and one-fifth the amount 
of albuminoids. The milk retained longest in the breast 
— the first milk drawn by the baby at each nursing — is the 
- thinnest ; the last, the richest. When, therefore, a baby 
seems to suffer from indigestion because of its mother's 
milk being too rich for it, it should take the first secre- 
tion from each breast at each nursing instead of drawing 
all the milk from one breast. One or two teaspoonfuls 
of water given the baby before each nursing have the 
same object. Should it, on the contrary, not seem to 
thrive because of the food not being sufficiently rich, the 
thin milk should be pumped or drawn out of each 
breast by the nurse or mother before the baby is allowed 
to draw. The two breasts are estimated to contain 
about two ounces of milk at one time.f 

* According to the analyses of Dr. H. Leffmann, the percentage of fat 
rarely reached 4, ranging between 2.5 and 3, as a rule, while the albumi- 
noids were usually a fraction over I per cent. 

f The use of from I to 5 drops of cod-liver oil, according to the age of the 
child, given three times daily, has been found to be a valuable supplement 
to the food when a mother's milk lacks richness. — Dr. A. E. Broomall. 



CARE OF THE NEW-BORN INFANT. 1 85 

The question of how to increase the secretion of milk is 
a very important one. The best way is by a judicious 
regulation of the mother's or wet-nurse's diet. There 
are no medicines which are entirely satisfactory for the 
purpose of stimulating the secretions. Therefore a nurse 
can do more than a doctor in this line by careful feeding 
of her patient. A mixed diet is the best for making 
milk. Beer and all kinds of liquors, as porter, etc., do 
more to fatten the mother or nurse than to make milk ; 
therefore they are to be avoided. In weakly women 
with poor appetites the malt liquors and bitter tonics are 
sometimes of advantage in stimulating the appetite and 
thus promoting a greater secretion of milk. The spe- 
cial diet for a nursing woman is laid down in another 
chapter. Good human milk should be three per cent, 
cream.* 

To determine the character of milk — human or cow's 
milk — an instrument known as the lactometer, or milk- 
tester ■, may be used, aided by the microscope. 

The Lactometer consists of a cylindrical glass vessel, 
or beaker, which should contain the milk to be tested, 
and a specific gravity glass, which is to be floated in 
the liquid. This glass is graduated and marked at 
certain points with letters and figures. Thus, W., P., 
and F. The W. stands for "water," P. for "pure," 



* As a general rule, the amount of fat may be increased by increasing the 
amount of meat in the diet, and the amount of albumin decreased by mod- 
erate exercise. Too little fat and too much casein make poor milk. — Rotch. 



1 86 



OBSTETRIC NURSING. 



and F. for " fat." Between the W. and P., at different 
points, are the fractions, %,%,%. Should the weighted 
glass sink in the liquid so that the surface of the liquid 
reached the mark W., the liquid tested would have the 
same specific gravity as water. Should the surface of 
the liquid reach the mark y, if it is milk that is tested, 



it would be 



y milk and 



3/ water. If the mark 



is 



/ 




m 



c 



touched, it is y 2 water and y 2 milk. 
In this way the adulteration of the milk 
with water is detected. Should the 
level of the liquid stand at P., we would 
have pure milk. Pure cream would 
raise the weighted glass so that the 
level of the liquid would stand at F. 
An ordinary urinometer may be used 
to obtain the specific gravity of milk 
in a similar way. Dr. Louis Starr sug- 
gests a good way to discover the pro- 
portion of cream in any given sample 
of milk: A narrow piece of paper, four 
inches long, is divided in its upper half 
inch by cross-markings into twelve 
equal parts. This paper is then pasted 
on the beaker of the lactometer with the marked portion 
uppermost, the lower edge touching the bottom of the 
beaker. Enough milk is then poured in to come just to 
the top of the paper, and the whole set aside for twenty- 
four hours. The cream rises and appears as a yellow 
layer at the top. This layer should have the depth ot 



b 



Fig. 31. — Lactom 
eter. 



CARE OF THE NEW-BORN INFANT. 1 87 

ten or twelve spaces, as marked on the paper. There 
is an inexpensive instrument known as the creamometer 
which serves the same purpose in determining the 
amount of cream in milk. 

On examination under the microscope, if there are 
but few oil globules in a specimen of milk, and if these 
oil globules be small, the milk is poor. On the other 
hand, if the oil globules in milk are too large, this be- 
comes a cause for its indigestibility. 

Should menstruation begin with a nursing mother, the 
milk may be so affected as to disagree with the child. 
Ordinarily, the menstrual flow does not recur until the 
eighth month after delivery. The appearance of the flow 
need not lead to a cessation of nursing, unless the milk 
should seem to disagree with the child. The character 
and quantity of the milk is impaired by deep or violent 
emotions; thus, anxiety, fear, anger, etc., will greatly 
detract from a woman's ability to be a good wet-nurse. 
Pregnancy always deteriorates the character of milk and 
is an indication for weaning a nursing child. 

Hand Feeding. — When the mother's milk utterly 
fails and a wet : nurse can not be had, hand-feeding be- 
comes necessary. For this purpose " modified cow's 
milk " may be used. 

Cow's Milk has a specific gravity of 1.029. The 
milk obtained from stall-fed cows gives an acid reaction; 
that from pasture-fed cows a less acid reaction. Could 
the latter be obtained directly from the cow, its reaction 
would be slightly alkaline, as with human milk. An 



1 88 



OBSTETRIC NURSING. 



analysis of the same quantity of woman's milk and 
cow's milk is reported as yielding the following 
results : 



Water, . . . 
Total solids, . 
Fat, . . . . 
Albuminoids, 
Milk-sugar, . 
Ash, . . . . 
Bacteria, . . 



Woman' 's Milk. 


Cow's Milk. 


87.88 parts 


86.87 parts 


12.13 " 


13.14 " 


4.00 " 


4.00 " 


1. 00 " 


4.00 " 


7.00 " 


4-5 " 


0.2 " 


0.7 " 


not present. 


present. 



The woman's milk for this analysis was obtained di- 
rectly from the breast. The cow's milk was, as it is 
ordinarily obtained in cities, about twenty-four hours 
old. 

By an examination of this analysis, it will be seen 
that the proportion of coagnlable substances of cow's milk 
is much greater than in human milk. This is where 
the difficulty in its digestion lies. Casein of human 
milk coagulates in light curds; in cow's milk in firm, 
hard curds. 

Quality of Food. — The kind of food required by dif- 
ferent babies will vary with their constitutions. As a 
rule, a mother's milk is the best food for her child, and 
makes a good gauge to start from in the preparation of 
an artificial food to take its place or act as a supplement 
when there is an insufficient supply. If, therefore, a 
careful analysis is made of a mother's milk and a mix- 
ture prepared which shall, so far as possible, contain the 



CARE OF THE NEW-BORN INFANT. 1 89 

same constituents in the same proportion, we may hope 
that the baby will thrive on it. A steady increase in 
the baby's weight will be the best index by which we can 
judge of the nutritive qualities of the food it is taking. 

Increase in Weight. — For the first four or five months 
of its life a child should gain on an averarge twenty to 
thirty grams (about one ounce) daily. For the re- 
mainder of the first year of life, a daily gain of from ten 
to fifteen grams will mark satisfactory progress. 

In the comparatively few cases in which a mother's 
milk does not appear to have proper nutritive or diges- 
tive properties, it should be examined to discover in 
what direction the deficiency lies, and the artificial food 
should be prepared so as to supply the lack. The 
nutritive constituents of milk are the albuminoids, fat, 
and milk- sugar. 

Modified Cows' Milk. — Cow's milk contains about 
four times the quantity of albuminoids found in human 
milk, so that it requires to be diluted with four times as 
much water to represent the same percentage of albu- 
minoids. Since the amount of fat in human and cows' 
milk is about equal, this dilution would greatly de- 
crease the percentage of fat. Also, since cow's milk 
contains a much smaller quantity of sugar of milk than 
is found in human milk, the same dilution would be 
greatly deficient in sugar. 

In preparing a mixture from cow's milk, therefore, 
which may correctly represent human milk, fat, in the 
form of cream, and sugar of milk must be added. 



IQO OBSTETRIC NURSING. 

Laboratories for the preparation of modified cow's 
milk according to the requirements of individual cases 
have been established in several of the large cities. 
Physicians are requested to send prescriptions giving the 
proportions of the different constituents of milk required 
for their patients, and from these the preparations are 
made, sterilized, and served daily to the patient. The 
prescription can be modified whenever required to meet 
conditions as they arise in the course of management. 

Cream varies very much in richness; hence it is de- 
sirable to know what percentage of fat is represented 
by the cream used in compounding a mixture. A 
chemical analysis of the cream is necessary for accuracy 
of result in such determination. It has been suggested 
that to prevent too much variation in the percentage of 
fat, the cream should be obtained of the same person 
from milk that has been allowed to stand each day for 
the same length of time and in the same temperature. 

Rotch's Formula for Modified Cow's Milk.— A 
mixture made up according to the following rule proba- 
bly most nearly resembles the average human milk. To 
make one pint of the mixture for use in twenty-four 
hours, take milk and cream (twenty per cent.) as soon 
as it comes in the morning, and mix as follows : 

Milk, fgij 

Cream, fo^J 

Water, fgx 



Milk sugar, gvi 



4 • 



Put in a flask in the steamer and steam for twenty min- 



CARE OF THE NEW-BORN INFANT. I9I 

utes ; then remove the flask from the steamer, and when 
still slightly warm add lime water f§j. Place on ice, 
and give the proper amount at the proper feeding time, 
warming the quantity of the mixture used in a water- 
bath before giving it to the baby. 

The object in steaming the mixture is to sterilize it, 
for human milk is sterile, and for that reason more 
digestible than cows' milk — which, although sterile 
while in the udder, becomes contaminated as it is placed 
in vessels and transferred from place to place. It is be- 
lieved by some that this steaming or boiling of milk 
has a tendency to decrease its digestibility. The danger 
from this source, however, is probably much less than 
that which would arise from the presence of germs in the 
milk, such as have been shown to exist. " Fractional 
sterilization" the heating of milk in a water-bath several 
times in succession up to a more moderate degree of 
heat than that required for complete sterilization (167 
F.), is said not to have the same effect in decreasing the 
digestibility of milk. 

Pasteurization of Milk. — The process which is 
known as Pasteurisation (after the French scientist, Pas- 
teur) is a modification of sterilization, the temperature 
of the milk being brought up only to 167 Fahrenheit 
instead of to 21 2°, which is done in sterilizing. It is 
claimed that this process destroys the germs suf- 
ficiently for all practical purposes. It does not, how- 
ever, with certainty kill the germs, hence a method 
has been suggested by which the milk can be brought 



I92 OBSTETRIC NURSING. 

to a higher degree of heat, and yet not lose its digesti- 
bility. 

The bottles of the sterilizer are filled and the apparatus 
made ready in the usual way, but the hood is left oft 
and the lid set ajar, while the heating is continued for 
forty-five minutes over a brisk fire. The temperature of 
the milk is thus brought up to about 190 . It has been 
found that milk thus prepared and kept in well-corked 
bottles will keep sweet for twenty-four hours. 

Lime-water is added to make the mixture alkaline, all 
human milk being slightly alkaline. It should not be 
placed in the flask before boiling or steaming, because 
experimentation has shown that the lime undergoes 
some change in the process of boiling which causes a 
discoloration of the milk and the deposit of a sediment. 
Experiment has shown that water is the most efficient 
diluent to be employed in making these mixtures, as it 
gives a much finer curd with acids, when so used, than 
can be obtained by an admixture with barley-water or 
any of the prepared foods. 

Having thus determined by analysis the quality of the 
food required for an infant, the quantity must be deter- 
mined and also the frequency of feeding. 

As to Quantity, the observations made by Dr. Ssnit- 
kin, of St. Petersburg, have led to the formulation of a 
rule by which one one-hundredth of the baby's weight 
should be taken as the figure with which to begin the 
computation, and to this should be added one gram 
for each day of life, 



CARE OF THE NEW-BORN INFANT. 



193 



A table prepared by Dr. Rotch, of Boston, has 
arranged in very convenient form the quantity and inter- 
vals of feeding for the first year of a child's life : — 



GENERAL RULES 


, FOR FEEDING.— (Rotch.) 


Age. 


Intervals 

of 
Feeding. 


Number 

of 
Feedings 

in 
24 Hours. 


Average 

Amount at 

Each Feeding. 


Average 
Amount in 
24 Hours. 


1st week. 


2 hours. 


10 


I ounce. 


10 ounces. 


1-6 weeks. 


2^£ hours. 
3 hours. 


8 


1^-2 ounces. 


12-16 ounces. 


6-12 weeks and 

possibly 

to 6th month. 


6 


^-4 ounces. 


18-24 ounces. 


At 6 months. 


3 hours. 


6 


6 ounces. 


36 ounces. 


At 10 months. 


3 hours. 


5 


8 ounces. 


40 ounces. 



Another table arranged by Dr. Rotch shows the 
amount required at each feeding, according to the weight 
of the child. 



DETERMINATION OF AMOUNT OF FOOD BY WEIGHT IN 
CASES OF SPECIAL DIFFICULTY. 



Initial 
Weight. 


Each Feeding. 


EARLY DAYS. 


AT 15 DAYS. 


AT 30 DAYS. 


3000 
grams. 


30 grams. 
(About I ounce. ) 

43 grams. 
(About \]/ 2 ounces.) 


30+15=45 grams. 
(About \y 2 ounces.) 

45 + 15=60 grams. 
(About 2 ounces.) 


30+30=60 grams. 
(About 2 ounces.) 


4500 
grams. 


45+3°=75 grams. 
(About 2^ ounces.) 


6000 
grams. 


60 grams. 
(About 2 ounces.) 


60+15=75 grams. 
(About 2^ ounces.) 


60+30=90 grams. 
(About 3 ounces.) 



194 OBSTETRIC NURSING. 

Stomach of Infant. — A new-born infant's stomach 
holds about I y 2 ounces. The average daily quantity of 
food required for the first two to three months is 20 
ounces; after three months, 23 ounces; after four 
months, 27 ounces ; six to twelve months, 30 ounces. 
The child's appetite, however, if it be healthy, is a good 
gage. During the first month, \y 2 ounces of the pre- 
pared cow's milk may be given at each feeding, and 12 
feedings given daily. 

Peptonized food, diluted, has been employed with 
great success by some physicians where the digestive 
powers in early childhood seemed at fault. The follow- 
ing formula may be used for the purpose : — 

Into a clean quart bottle put one measure, or five 
grains, of extractum pancreatis (Fairchild's), and one 
measure, or fifteen grains, of bicarbonate of soda, and a 
gill of cold water ; shake, then add a pint of fresh cold 
milk, and shake the mixture again. Place the bottle in 
water at about no° or 115 , or just so hot that the 
whole hand can be held in it for a minute without dis- 
comfort. Keep the bottle there for twenty minutes. At 
the end of that time put the bottle on ice to check fur- 
ther digestion and to keep the milk from spoiling. 

If heat cannot be conveniently provided, after the in- 
gredients have been thoroughly mixed and shaken the 
bottle may be placed on ice and allowed to stand for an 
hour before it is used. 

It must be remembered that peptonized milk cannot be 
sterilized, as it then becomes unfit for food — the process 



CARE OF THE NEW-BORN INFANT. 1 95 

of digestion being carried so far as to curdle the milk and 
render it extremely unpalatable. Steiilized or Pasteurized 
milk may, however, after it has cooled, be peptonized. 

If an additional aid to the digestion should be neces- 
sary, a little pepsin may be given to the child just before 
each feeding, or the pepsin, or any of the powdered pre- 
parations used to aid digestion that may be prescribed 
by the physician may be placed in the nursing bottle 
just as the child takes it. Pancreatic extract and soda, if 
used, will need to be given about an hour after the meal. 

Favorite Formulae for Modified Milk. — A prepara- 
tion of modified milk which has been much used by Dr. 
Broomall is the following, in amount for a single feed- 



ing:- 



Cream, I teaspoonful 

Milk, .• 3 teaspoonfuls 

Lime-water, 2 teaspoonfuls 

Boiled water, 10 teaspoonfuls 

Milk sugar, % teaspoonful. 

To make this up in quantity for sterilization the fol- 
lowing proportions are required : — 

Cream, ^ ounce 

Milk, I ounce 

Lime-water, . I ounce 

Water, 17 j4 ounces 

Milk sugar, 6 ounces. 

Another favorite formula in Philadelphia is that of Dr. 
Meigs, known as Meigs' Food : — 

Cream, 2 parts 

Milk, I part 

Lime-water, 2 parts 

Sugar water, 3 parts. 



I96 OBSTETRIC NURSING. 

The sugar water is prepared by putting eighteen table- 
spoonfuls of milk sugar to a pint of water. 

Dr. Louis Starr gives a very useful dietary for infants, 
which has also met with great success. Those formulae 
which especially concern the obstetric nurse are as 
follows : — 

Diet for first week : — 

Cream, 2 teaspoonfuls 

Whey,* 3 teaspoonfuls 

Water (hot), 3 teaspoonfuls 

Milk sugar, % teaspoonful 

for each portion ; to be given every two hours, from 5 
a. m. to 11 p. m., and in some cases once or twice at 
night, amounting to twelve fluid ounces of food per day. 
Diet from the second to the sixth week : — 

Milk, I tablespoonful 

Cream, 2 teaspoonfuls 

Milk sugar, j£ teaspoonful 

Water, 2 tablespoonfuls 

for one portion, to be given every two hours, from 5 a. m. 
to 11 p. m., amounting to seventeen fluid ounces of food 
per day. 

The proportion of milk in the mixture and the quan- 
tity given at one time are carefully increased during the 
succeeding weeks. Not until it is about nine months 
old can a baby well take undiluted cow's milk. When 
milk cannot be borne, diluted cream, one part to five or 

* Whey is made by the use of rennet, or by adding three teaspoonfuls of 
wine of pepsin to a quart of warm, fresh milk, and placing the mixture near 
the fire for two hours. The curd is removed by straining through muslin. 



CARE OF THE NEW-BORN INFANT. 1 97 

six of water, or barley water, makes a serviceable mix- 
ture, or cream and whey may be combined thus : — 

Cream, I ounce 

Whey, 2 ounces 

Warm water, 2 ounces 

Milk sugar, I teaspoonful. 

{Griffith.) 

For those unable to follow any elaborate formulae, the 
following plain directions for making cow's milk resem- 
ble human milk may be given : — 

Simplified Formula for Modified Cow's Milk. — 
Take of "top milk" (the upper portion of good milk 
which has been allowed to stand in a suitable place six 
to eight hours) one part, and add to this two parts of 
water. This gives about the same proportion of cream 
and curd as in mothers' milk, but lacks sugar. Milk 
sugar (obtainable at any drug store) may be added to 
this in the proportion of one heaping teaspoonful to 
every four ounces of the mixture. If cane sugar is used, 
a teaspoonful should be added to every six ounces.* 

The Temperature of the Food should be 99 ° Fahr. 
It is a great mistake to make it too hot. The warming 
of the child's food should be accomplished by setting 
the filled nursing bottle into a vessel of hot water. It 
may be heated quickly over a gas jet by setting the 
bottle into a tin mug filled with water and holding it 
over the flame. Suggestions concerning the modifica- 
tion of food, when milk thus prepared does not agree 

* For Dr. Rotch's formula see page 190. 



I98 OBSTETRIC NURSING. 

with infants, will be given in another chapter. When 
the mother's supply of milk is scanty and the baby cries 
with hunger, occasional meals of the above preparations 
will be a great aid in its management. 

Sterilization of Milk. — By sterilizing milk is meant 
the process of destroying any poisonous matter which 
may have found its way into it. Exposure to the atmos- 
phere and admixture with particles of dust and dirt 
during its transportation, with want of care as to clean- 
liness of vessels, etc., in which the milk is kept, induce 
certain fermentative changes, which cause it to sour and 
to produce digestive disturbances. Sterilization destroys 
the germ of poisonous matter by subjecting the milk to 
a high degree of heat under pressure. Many forms of 
apparatus have been devised for this purpose. The 
accompanying cut represents one form. That shown in 
the cut consists of an oblong case of tin fitted with a 
tight cover. Into this a movable wire basket, holding 
ten bottles, is placed. The bottles are of flint glass, 
graduated, and fitted with rubber corks having a glass 
plug fitted into an opening in their centers. The rules 
for using the sterilizing apparatus are as follows : — 

1st. Cleanse the bottles thoroughly. 

2d. Fill each with the milk you wish to use, put in 
the rubber cork without the glass plug (this leaves a 
small opening in the rubber cork) ; set the bottle in the 
basket, then in the boiler; fill the boiler with water 
almost as high as the milk in the bottle; boil about ten 
minutes, or, better, as Dr. Starr expresses it, " until the 



CARE OF THE NEW-BORN INFANT. 



I 99 



expansion that precedes boiling has taken place in the 
milk; " then put the glass plugs tightly in each stopper 
and boil for fifteen or twenty minutes more. Should the 
rubber corks incline to come out during the second boil- 
ing, put them in firmly. 




Fig. 32. — Sterilizer. — {Dr. Lords Starr. ,)* 

3d. Keep in a cool place till needed for use. 

4th. When to be used, place a bottle of the milk thus 
prepared in the tin mug which accompanies the appara- 
tus. Pour hot water in the mug until it is as high as the 
milk in the bottle. Heat the milk to the temperature 



* " Hygiene of the Nursery." 



200 OBSTETRIC NURSING. 

desired for feeding (99 ° Fahr.) ; remove the rubber cork 
and put on rubber nipple, and feed. 

5th. Cleanse each bottle immediately after the milk in 
it is used. Do not keep milk in a bottle that has had 
some used out of it. 

6th. If the steaming process is preferred, place the 
basket, without the bottles, in the .boiler, fill with water 
up to but not above the bottom of the basket, place the 
bottles in the basket, and proceed as before. 

Milk should be sterilized or Pasteurized as soon as 
possible after it has been served each morning. Each 
bottle, when emptied, should be thoroughly washed. If 
the whole contents of the bottle are not used after it is 
opened, the remainder must not be used for the child 
nor allowed to remain in the bottle. 

Milk sterilized in this way will keep for days without 
spoiling, as it is hermetically sealed and has been de- 
prived of all unhealthy germs. Dr. Louis Starr makes 
the assertion that it will keep for eighteen days if the 
heating is continued for thirty minutes. 

Sterilized milk is useful when traveling, as it may be 
carried without any trouble, the difficulty of obtaining 
fresh milk being thus overcome. Its use makes the 
management of babies during the heat of summer much 
easier. 

A word remains to be said concerning feeding-bottles 
and rubber nipples. 

The Nursing Bottle should be of clear glass, with a 
rounded bottom, of a shape convenient to clean, so that 



CARE OF THE NEW-BORN INFANT. 



201 



no particles may cling about corners which cannot be 
reached, serving as a source of trouble afterward. The 
graduated bottle is very convenient, as it enables the 
quantity of each of the materials used in the preparation 




Fig. 33.— Graduated Nursing Bottle.— {Dr. Louis Starr.) 



of the feeding to be mixed directly in the bottle, 
instead of being first measured out in a graduate. 

Feeding-bottles with India-rubber tubes are very ob- 
jectionable, for the tubes are difficult to keep clean, and 



202 OBSTETRIC NURSING. 

a drop or two of milk left behind will often be sufficient 
to turn the next supply sour, causing the infant much 
sickness and suffering. Nurses are prone, also, with 
these tubes, to place the baby in its crib with the bottle 
of milk by its side and the nipple in its mouth. The 
heat of the child's body tends to sour the milk, the 
liquid may run low, and the child suck in considerable 
air. The neck of the bottle should always be kept filled 
with the liquid while the child is nursing, hence the 
position of the bottle must be changed. A feeding- 
bottle fitted with a rubber nipple requires to be held in 
the nurse's hand during the feeding, and is, on that 
account, to be preferred. There should always be two 
nursing bottles for each baby, one being kept under 
water or filled with a soda solution while the other is in 
use. Immediately after the meal the bottle should be 
cleaned, etc. Scalding water should be used, and then 
the bottle filled or placed beneath a solution of bicar- 
bonate of sodium — ordinary baking soda — a teaspoonful 
to the pint, until it is again needed, when the soda solu- 
tion should be emptied out and the bottle thoroughly 
rinsed with cold water. Some use salicylate of sodium 
for the cleansing solution in preference to the bicar- 
bonate. 

Rubber Nipples. — Two nipples should be in use at 
the same time, being used alternately, and no nipple 
should be used longer than two weeks. A soft rubber 
nipple of conical shape is the best, because it can be 
more readily cleaned. The black rubber is generally 



CARE OF THE NEW-BORN INFANT. 203 

softer than the white, and is to be preferred. The open- 
ing- at the top of the nipple should not be too large, as 
that would permit the milk to flow through, whereas the 
suction produced by the child's mouth is necessary to 
the food being taken in a natural manner. So soon as 
the meal is over, the nipple should be removed from the 
bottle, brushed with a stiff brush, wet with cold water 
on the outside, then turned inside out and similarly 
brushed on its inner surface. It should then be put in 
cold water and allowed to stand until wanted. A 
nurse's sense of smell should be keen enough to enable 
her to detect the slightest sourness about 
a bottle or nipple. 

The baby should be fed slowly — tak- 
ing often ten to twenty minutes for its 
meal. Sucking from an empty bottle 
should never be permitted. 

It is a bad plan to make the whole F * G - 34- -Rubber 

~ Nipple.— (Starr.) 

day's supply of food in the morning, 
unless the facilities for keeping it are such as to insure 
against its spoiling. When a sterilized preparation is 
used, it is desirable to have the whole amount prepared 
at once in a number of small flasks, each containing the 
amount for one feeding. 

The sterilization of the quantity of milk to be used 
during the day may all, however, be accomplished at 
one time. 

Home-made Sterilizer.— In lieu of the regular ster- 
ilizing apparatus, milk may be similarly boiled in a 




204 OBSTETRIC NURSING. 

water-bath formed by any ordinary boiler, the milk being 
contained in a glass fruit-jar with a screw lid. After 
coming to the boiling-point, or boiling about two minutes 
without the lid, the latter may be screwed on and the 
boiling continued. A better way is to put the jar in a 
colander placed over a steaming tea-kettle in place of 
the lid. The milk should be allowed to boil in the open 
jar for about two minutes ; the jar lid then being screwed 
down, it should steam for twenty minutes. 

Fresh Air. — Besides good food and sufficient warmth, 
babies need an abundant supply of fresh air, hence the 
room should be kept pure and wholesome. 

In fine weather, after the first three or four weeks, a 
baby should be carried out in the open air every day 
for a time. 

It is preferable to carry the child in the arms, rather 
than to place it in a baby-coach. It can thus be kept 
warmer, and any evidence of chilling will be sooner 
detected by the appearance of the baby's face. When it 
is not practicable to take the child out, the baby warmly 
wrapped may be carried about in a room, the windows 
of which have been raised, and free ventilation obtained. 



CHAPTER XIII. 

CHARACTERISTICS OF INFANCY IN HEALTH AND 

DISEASE. 

A healthy baby, if born at full term, should weigh 
3250 grams, or about seven pounds. Its length should 
be, on an average, 50 cm., or twenty inches. 

Development. — The head and trunk of the child are 
developed out of proportion to the limbs, so that the 
navel is below the middle of the child's body. This 
greater development of the upper part of the body is 
due to the fact that in the womb this portion of the 
child's body receives the greater amount of nourish- 
ment. The subsequent growth consists largely in the 
development of the lower limbs. 

The skin of a new-born baby varies in color from a 
pink to a decided red. The redness is more marked in 
premature babies. From the third to the fourth day 
this redness disappears, and the peculiar yellowish tinge, 
known as " baby jaundice," appears, as a result of the 
changes in the circulation. This is not true jaundice. 
This yellowish tinge of the skin should disappear by 
the end of the second week. At the same time that 
the skin begins to change color, from the third to the 

205 



206 OBSTETRIC NURSING. 

fourth day, it begins to scale or peel off. This is most 
noticeable about the fifth day, and lasts about sixteen 
days. 

The baby's limbs should be plump and well-rounded. 
The abdomen is prominent, as compared with the chest. 

The shape of the head varies very much. At times it 
is perfectly rounded, again it will be elongated and oval- 
shaped. 

Pressure during labor, either from the walls of the 
pelvis or as a result of the use of instruments, will cause 
at times considerable temporary distortion in the shape 
of the head. To allay swelling and prevent discolora- 
tion induced by bruising, fomentations may be used, 
either of simple hot w T ater, or hot water containing a 
little fluid extract of hamamelis. Sometimes it is better 
to use cold applications, if the child is not too feeble. 

When there has been a good deal of pressure on the 
baby's head during the birth, the bones will sometimes 
override each other, and this will be shown by eleva- 
tions or ridges upon the baby's head, which soon dis- 
appear when the head is no longer subjected to pressure. 
These ridges, which are converted into soft grooves on 
the removal of pressure, indicate the separation between 
the different bones of the head, and are called " sutures." 
The larger soft places are called " fontanelles." The 
largest is on top of the head just above the forehead. 
It is called the " anterior fontanelle," commonly known 
as " the opening of the head." It is about large enough 
for the tips of two fingers to cover, when of normal 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 20/ 

size, and is kite-shaped. A much smaller three-cornered 
fontanelle is found at the back of the head, and two be- 
hind the ears. These very soon fill up with bone. 

The large anterior opening does not close entirely 
until a child is about eighteen months of age. Should 
it remain open longer, it is a sign of constitutional 
weakness. In a healthy baby the surface of this fon- 
tanelle should be on a level with the surrounding bones 
of the skull. A slight pulsation may be noticed in it, 
due to the pulsation of the blood-vessels in the brain. 
Should the fontanelle be much depressed at any time, it 
would indicate a low state of vitality. Care should be 
taken not to permit any undue pressure on this part of 
the baby's head, as the brain here lies very near the 
surface. 

The fashion some old monthly nurses have of trying 
to shape the head by the pressure of the hands is dan- 
gerous, as the brain may be thus injured. As the head 
bones are soft, the child should not be allowed to lie 
too continuously on either side or on the back, as this 
will cause flattening of the part pressed upon. 

The first hair of the new-born baby, if it has any, is 
apt to fall out. The eyes of all new-born babies are ot 
rather an indefinite color — a sort of blue. A change gen- 
erally occurs when the child is about two months old. 
At this time also vision is nearly perfect. A new-born 
baby probably cannot do more than distinguish light 
from darkness. Hearing and the sense of smell develop 
rapidly in a child. Loud noises waken it as early as 



208 OBSTETRIC NURSING. 

during the first week. By three months of age the 
child shows that it has a mind and is capable of exer- 
cising thought. It grasps after objects and indicates by 
its expression and gestures its likes and dislikes. By 
the age of eight or ten months it utters several syllables, 
and at the age of a year should be able to say " papa " 
and " mamma." By two years of age short sentences 
can be used. 

Weight of Baby. — For the first two days of a baby's 
life it loses weight, but by the third day it begins to 
gain, and by the end of the first week it should weigh 
what it did at birth. The average daily gain is 30 
grams, about 1 oz. The following facts concerning the 
early changes in weight are obtained from Gregory : — 

An infant born at full term weighs from 6 to 7 pounds, 
7 pounds being an average weight. For the first two or 
three days of life there is a loss of 4 ounces to 7 ounces, 
then a regular gain, so that by the eighth to the ninth 
day the initial loss has been made good. The following 
figures express the average daily loss and gain during 
the first six days of life : — 

First day, Loss of 139 grams, or nearly 5 ounces. 

Second day, .... " 64 " " 2^ ounces. 

Third day, ...... Gain of 33 " about I ounce. 

Fourth day, " 50 " " I ^ ounces. 

Fifth day, " 50 " " 1^ ounces. 

Sixth day, " 36 " " 1% ounces. 

The child's weight should be doubled in the fifth 
month, and trebled in the twelfth month. The baby 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 2O9 

should be able to hold up its head in the sixteenth week, 
at the same time sitting up. It should stand by the 
thirty-eighth week. It should "take notice" and be 
able to grasp things by the third to the fourth month. 

It is important that a nurse should know the above 
facts as to the child's development, to be able to report 
satisfactorily concerning its condition to the physician 
in attendance. 

Sleep. — A large proportion of the time of early in- 
fancy is spent in sleep. The more premature the baby, 
the more constantly does it sleep. During sleep the 
eyelids should be tightly closed. A partial separation 
of the lids, showing the whites of the eyes, is an indica- 
tion either of some disease, or of pain, from whatever 
cause. 

The Respirations of a healthy baby when awake 
may be very irregular, some inspirations being shallow 
and others deep — at times hurried, and again slow. The 
only time when the respirations can be satisfactorily 
counted is when the child is asleep, for then the breath- 
ing is more regular. The rise and fall of the abdomen 
may then be noted (for the breathing of an infant is 
abdominal). The number of respirations in a minute 
average 44. So quiet is the healthy breathing of early 
infancy that there is no motion of the nostrils or of the 
lips, or even of the chest, to indicate the incoming and 
outgoing of air. Fever, colic, and lung trouble will 
greatly increase the number of respirations in a minute, 
making them mount up to 60 or 80, or even higher. 



2IO OBSTETRIC NURSING. 

Nervous excitement has a similar effect, though this is 
temporary. 

In brain trouble a slowing of the respirations occurs, 
so that they may get down to eight in a minute. When 
the act of breathing is painful, a moan or cry accompanies 
each act of respiration. The expansion of the nostrils 
with each inspiration indicates a want of sufficient air 
space in the lungs. In connection with any lung trouble 
a bluish coloration of the lips and face generally is a bad 
symptom, as it indicates that sufficient air does not enter 
the lungs to purify the blood. 

The Pulse. — Little reliance is to be placed upon the 
pulse of a baby as indicative of disease, for it is character- 
istic of the infantile pulse that it is very rapid, very easily 
affected by external or internal causes, and notably 
irregular. The average pulse of the new-born baby is 
140. If a baby is well-nourished, it is too fat to enable 
the pulse in the radial artery to be counted. Hence 
the pulse is more easily obtained in the temple or at the 
ankle. If not thus readily obtained, the heart-beats 
may be counted by holding the hand over the baby's 
heart. 

The Temperature of a child at this age is also 
subject to rapid changes, the result of slight causes. 
The average temperature is 99 ° Fahr., but a cold or an 
attack of indigestion may cause a sudden increase, with 
as sudden a return to normal when the cause is removed. 

A subnormal temperature is an indication of lowered 
vitality, the result of some drain upon the system, as of 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 211 

an exhaustive diarrhea, or of some constitutional weak- 
ness. This fall of temperature is a dangerous symptom 
in infants. The tip of the nose and the extremities of 
the child, if cold, also indicate a condition of low vitality, 
and require that the child should receive very especial 
care from the nurse as to the supply of food and warmth. 
In fever the back of a child's head feels very hot, as 
also do the palms of the hands. 

The Cries of a Child form a special language by 
which its needs may be made known. Every nurse 
should learn to distinguish the peculiarity in the differ- 
ent kinds of cries, so as to meet the varying demands 
thus indicated. A healthy, well-trained baby rarely 
cries, unless hungry, when the cry will be constant and 
very persistent until the want is satisfied ; the upper part 
of the body is moved at the same time, especially the 
arms and head. The cry induced by ear-ache is also 
unappeasable, and generally accompanied by a drawing 
of the hand up to the head. A similar gesture accom- 
panies the cry induced by brain trouble, which is a shrill 
scream, often waking the child during sleep. 

A cry accompanying a cough is an indication of pain in 
the chest. The paroxysmal character of colic is indicated 
by the characteristic cry which accompanies it, — a sharp, 
sudden cry, — the limbs at the same time being drawn up 
toward the abdomen. An evacuation of the bowels may 
precede or follow the cry. 

Sore Mouth. — If, in nursing, a baby seizes the nipple 
by the mouth and drops it suddenly with a cry, doing 



212 OBSTETRIC NURSING. 

this repeatedly, there is in all probability some soreness 
of the mouth, which should be discovered and treated. 
However heartrending the cry, the baby does not se- 
crete tears in sufficient quantity to run down the cheeks 
until the third month of infancy. Hence the common 
saying, that a baby cannot suffer pain because it sheds 
no tears while crying is not supported by fact. 

Facial Expression. — A wrinkling of the forehead 
vertically, produced by drawing the eyebrows together, 
indicates pain about the head. A sharpening or play 
of the nostrils exists in lung troubles. A drawn look 
about the mouth is found with digestive troubles, as 
flatulent colic. 

The Stools of a very young baby fed on breast milk 
should be of a yellow or orange color. Three or four 
evacuations a day are natural. They should contain no 
curds. Stools of bottle-fed babies are lighter and more 
offensive. 

Urination. — The number of times a new-born baby 
urinates will vary much with the weather and the condi- 
tions under which the child is placed. It is not unusual 
in cold weather for the napkin to need changing almost 
every hour. Healthy urine should not stain the napkin. 

Mothers and nurses are often much troubled by the 
failure of an infant to pass urine or feces for the first 
few hours or days of its life. A careful examination of 
the anus or external opening of the bowel will soon show 
whether there is any imperforate condition of the rec- 
tum which may cause the retention of feces. Closure 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 213 

of the urethrals so rare that retention of urine is very 
seldom seen. 

The new-born infant secretes but very little urine 
until it begins to take nourishment freely. The bladder 
is usually emptied during the process of birth, which is 
very frequently the case with the bowels, so that if the 
child seems well and there is no malformation of the 
parts, the family may be assured that the condition is 
only temporary. 

The use of fomentations over the kidneys and bladder 
will frequently hasten the evacuation of urine if it be 
unduly delayed. If the secretion seems highly concen- 
trated, as is shown by the brickdust deposit sometimes 
found on the baby's diaper, a drop of sweet spirits of 
niter in a teaspoonful of water may be given once in 
two hours. 

Should the child seem to suffer pain from the reten- 
tion of the contents of the bowel, an ounce of warm 
water or olive oil injected into the rectum will usually 
produce a satisfactory evacuation. Should a laxative 
by the mouth be needed, the physician must be con- 
sulted. A teaspoonful of sweet oil often serves the pur- 
pose very nicely, or a few grains of manna dissolved in 
milk. 

The Teeth sometimes appear prematurely. A child 
may be born with one or more teeth already cut. These 
are usually imperfect, and fall out in a short time, to be 
replaced by the milk-teeth. The latter are twenty in 
number, and are usually cut in groups, starting about the 



214 OBSTETRIC NURSING. 

fourth month and continuing till between the twentieth 
and thirtieth months, when the first dentition should be 
complete. There is an interval of rest as a rule between 
the eruption of each group. Girls are more apt to cut 
their teeth early than boys, and, as an early dentition is 
usually an easy one, it is fortunate for the child to have 
it occur early. 

Even under normal conditions the edges of the gums 
in teething become swollen, rounded, and reddened as 
the teeth come near the surface. The saliva is at the 
same time increased in quantity, and the mouth is 
heated and uncomfortable, so that the child desires con- 
stantly to bite upon any object that may be at hand. 
A healthy child should not suffer in any way from the 
process of dentition, and when the point of the tooth 
comes through the gum the local symptoms may vanish. 

The following diagram will illustrate the order in 
which the teeth are cut. The numbers I to 5 show to 
how many groups the several teeth belong and the 
order in which the groups appear. The letters a and 
b show the order in which the teeth in each group 
appear. 

Bottle-fed babies are more apt to be late cutting their 
teeth than those that are breast-fed. If no teeth have 
appeared when the child is a year old, we may know 
that the child's general nutrition is at fault, or it may 
have the disease known as rickets. 

Bottle-fed babies are also apt to have their teeth come 
through the gum in irregular order. This frequently is 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 21 5 

an indication of lack of health, although sometimes it is 
a family peculiarity. 

The first set of teeth which the child has is called the 
temporary set. It consists of twenty teeth, known as 
milk teeth. The permanent set, of which the first appear 









a 


a, 


ct 


4 


2 


2 


2 


3^ 






( r 






Fig. 35. — Diagram Showing Eruption of Milk Teeth.* 

1. Between the fourth and seventh months. Pause of three to nine weeks. 
2, 2. 2, 2. Between the eighth and tenth months. Pause of six to twelve 
weeks. 3, 3, 3, 3, 3, 3. Between the twelfth and fifteenth months. Pause 
until the eighteenth month. 4, 4, 4, 4. Between the eighteenth and twenty- 
fourth months. Pause of two to three months. 5, 5, 5, 5. Between the twen- 
tieth and thirtieth months. 



at about six years of age, consists of thirty-two teeth. 
They push upward in the jaw and loosen the first set, 
gradually displacing them. 

Walking. — Many children creep before they walk, 



* From Starr, " Diseases of the Digestive Organs in Infancy and 
Childhood." 



2l6 OBSTETRIC NURSING. 

and in that case may prefer this means of locomotion to 
walking. A child usually creeps as early as seven or 
eight months. At about ten months the child may walk 
by holding on to things. Strong children may walk 
alone at one year of age. With weaker children this 
may be delayed until two years. 



CHAPTER XIV. 
THE AILMENTS OF EARLY INFANCY. 

It is not proposed in this chapter to take up all the 
ailments of infancy, for the term infancy comprises a 
time beginning with the birth of the child and lasting 
until the first dentition. 

The obstetric nurse remains with the patient from 
four to six or eight weeks. During this time many 
deviations from the normal, healthy state may be met 
with in the child, and these she should be quick to 
observe and know how to manage. 

Prematurity. — One of the most important conditions 
of this period is " prematurity," a result of the too early 
birth of the child. 

A premature birth is one that occurs at any time after 
the child is " viable " — that is, capable of living after its 
birth. The term of viability has been set at twenty-eight 
weeks, or seven lunar months. Deliveries occurring 
previous to this time are called " miscarriages." 

It may be that, with improved methods of manage- 
ment, the period of viability may be placed at an earlier 
date, but this is as yet a matter for proof.* 

• * The French claim that by means of gavage and the couveuse, or 
hatching-cradle, the actual period of viability has approached six months 
of intrauterine life. 

217 



2 18 



OBSTETRIC NURSING. 



It has generally been conceded that a child born at 
six lunar months cannot live, that at seven months it 
stands little chance, that at eight months its chances are 
better, and at nine still better. 

The popular notion that an eight- month baby (count- 
ing the calendar months) does not stand so good a 
chance of living as a seven-month baby is altogether 
wrong. Great care is needed for premature babies. 




Fig. 36.— Tarnier's Couveuse.* 



They especially need regular feeding and to be kept 
very warm. The skin, being thin and delicate, will also 
require very careful attention. 

Until within a few years the matter of keeping the 



* Dimensions of couveuse for a single infant : Width, 36 cm. ; length, 
65 cm. ; height, 55 cm. For twins a larger case is necessary. The tem- 
perature within the incubator should be kept at from 85 ° to 95 Fahr., as 
determined by a thermometer laid in upper compartment. 



THE AILMENTS OF EARLY INFANCY. 



219 



baby sufficiently warm was exceedingly difficult to man- 
age. The French invention of the " couveuse," or 
" brooder," has simplified the matter very much. The 
first incubator for the rearing of premature infants was 
made in 1857, at Bordeaux. It was crude in construc- 




Fig. 37— Auvard's Couveuse (Interior View).* 



tion as compared with more modern inventions, but 
yielded very satisfactory results. In 1880 Professor 
Tarnier, of Paris, constructed an apparatus, consisting of 



* In Auvard's couveuse a cylindrical reservoir of metal takes the place 
of the hot- water jars in lower compartment of Tarnier 's couveuse. This 
is rilled by means of a metallic funnel fastened to one end of the box and 
communicating with the cylinder. An overflow pipe carries off the excess 
of water upon the addition of more hot water as required.— "Archives de 
TocologieV 



220 OBSTETRIC NURSING. 

a box with an upper and a lower chamber, which com- 
municated with each other, and which was heated by 
stone jars filled with hot water in the lower chamber, the 
upper serving as the bed for the child. Suitable means 
for regulating the degree of heat were provided by venti- 
lators, etc. Dr. Auvard later improved this incubator 



Fig. 38. — Auvard's Couveuse (Exterior View). 

and presented it to the Maternity Hospital at Paris, 
where it served to prove most successfully that artificial 
means could be employed for increasing the chances of 
life with premature infants.* In 1891 M. Lion, of Nice, 



*Crede's incubator is a copper vessel with double walls, between 
which water at the desired temperature may be kept, and withdrawn by 
means of pipes and stop-cocks. 



THE AILMENTS OF EARLY INFANCY. 221 

improved upon any of the forms of apparatus earlier 
devised, and achieved the most wonderful results by his 
invention, which is now much used. 

The Lion Incubator. — "The Lion incubator is com- 
posed entirely of metal and stands upon iron supports. 
It can be disinfected without deterioration by means of a 
steam stove under pressure. Ventilation is obtained by 
means of a tube of about three inches in diameter, with 
a chimney of the same size. A screw placed on the top 
indicates by its rotation the strength of the current of 
air. The front of the incubator is fitted with a glass 
window, through which the child may be seen, while on 
the left is another glass window, which enables the 
mother or nurse to attend to the wants of the infant, 
and, if necessary, to remove it. The baby is laid in a 
metallic hammock placed in the center of the incubator, 
thus enabling the warm air to circulate freely about it. 
A thermometer placed at the level of the infant's head 
regulates the working of the apparatus. The heating is 
effected by means of a siphon, through which the hot 
water circulates, and which communicates with a reser- 
voir at its side. A special system of pipes allows the air 
to pass directly from the interior into the apparatus. In 
these pipes the air is filtered before it enters the incu- 
bator. The temperature is automatically regulated, and 
the current of heat is increased or diminished as required, 
and without variation."* 



*From Catalogue of Lion Institute, Paris. 




lull, Dll liLiiLli hill ill IlililJIIIIIIiifc 

:;iii!i!!iriiiii!iiii!!in 

tlllllRIMIWUia 

I III II lllbilli1l.nl .ilil II Ml Illy mill 

■HM «!*)■» lb 




Fig. 39. — Incubator for Premature-born Children.* — {K?iy-Scheerer Co. 

New York.) 



* The apparatus is constructed of steel, with glass doors and one glass 
window on the side for feeding purposes, etc. The heat generated in C 



THE AILMENTS OF EARLY INFANCY. 223 

Modifications of the Lion incubator are made in this 
country. The accompanying cut shows the one in use 
at the Maternity connected with the Woman's Hospital. 

The child should be placed in the upper compartment 
of the couveuse as in its cradle, being removed simply 
for nursing, its bath, and toilette. If artificially fed, it 
can be managed through the side window, without 
removal from the incubator. When removed from the 
couveuse, care should be taken to have the temperature 
of the room sufficiently warm. It should be as nearly 
as possible the same as the temperature within the 
couveuse — between 87 and 90 Fahr. 

Auvard recommends the use of the couveuse in all 
cases where the vitality of the child is enfeebled either 
by external causes, as cold, or internal causes, as prema- 



communicates itself to the water filled tubes on the inside, maintaining 
a uniform temperature at any desired point by means of a spiral thermo- 
regulator inside, K, which is controlled by micrometer adjustment from out- 
side, H and F. The hygrometer, L, records the atmospheric conditions of the 
chamber. The air supplied to the infant is filtered through an absorbent 
cotton filter in box A ; this air can be taken from the room in which the 
apparatus is placed or directly from the outside by means of simple tubes. 
"The revolving wheel, M, in chimney indicates the perfect circulation of air. 
The cup D is a feeding reservoir for the supply of water circulating in 
the pipes, and communicates with the siphon at the point E. When 
the apparatus is in active use the cup will need filling about once in three 
hours. The gas-burner B is connected with a gas pipe in the apartment 
in which the apparatus stands, either by rubber-tubing or, preferably, by 
close metallic connection. A thermometer is fastened to one side of the 
upper compartment of the apparatus. A frame for a chart containing 
records of the condition of the child is found on the top of the apparatus. 



224 



OBSTETRIC NURSING. 



turity, congenital feebleness, cyanosis, or "blue disease," 
wasting, or other general maladies enfeebling to the new- 
born. 

Swaddling. — Before the couveuse was known, pre- 
mature babies were swaddled in cotton, in order to be 
kept sufficiently warm. The directions for doing this 
are as follows : — 

Take a square baby-blanket and place it diagonally 
on the table or bed. Turn down one corner for four 
inches' distance, to come up over the baby's head. 




Fig. 40.— Swaddled Baby. 



'Spread over this blanket a lap of raw cotton. Have the 
baby's napkin and binder on, and a flannel undervest. 
Make a cap out of the cotton, fitting it over the baby's 
head and bringing it down well under the chin. Then 
roll the baby up in the cotton lap. Bring the blanket 
around this firmly, so as to hold it ; the portion of the 
blanket on the baby's right being brought over and 
tucked in on the left side, the portion on the left being 
correspondingly folded over toward the right. The 
corner of the blanket left at the feet is then folded up 



THE AILMENTS OF EARLY INFANCY. 225 

over the front, and the whole held in place by means ot 
a strip of muslin bandage or ribbon. The bandage is 
first applied beneath the chin, crossed under the back, 
and again crossed in front, the ends being brought for- 
ward to fasten in a bow-knot at the feet. 

The great disadvantages of this method may be seen 
in the restriction it gives to the movements of the child's 
limbs, and the difficulty of determining when the child's 
napkin needs changing, also the frequent exposure of the 
child during these changes to the ordinary atmosphere. 

Home-made Incubator. — An ingenious method of 
maintaining the body-heat of a baby, and one readily 
accomplished in any household, is described as follows 
by Dr. Reynolds : — 

" A large basket should be thickly lined with heated 
blankets or other flannels. A number of bottles, filled 
with very hot water, should be so arranged around the 
sides of the receptacle that they can be removed and re- 
inserted without disturbance of the infant. The child is 
wholly covered, with the exception of its face, with well- 
warmed cotton batting, and is laid between the bottles ; 
and the cradle is then covered with a thick blanket, a space 
at the end which corresponds to the child's head being left 
open to permit the entrance of air. A thermometer should 
be laid beside the child, and one or more of the bottles 
should be refilled with hot water whenever the tempera- 
ture is seen to fall below 8y° F. The water should not, 
on the other hand, be so hot as to raise the temperature 
of the contained air much above 90 F." 
15 



226 OBSTETRIC NURSING. 

Stimulation. — If the baby be very weak, it may be 
necessary to stimulate it for two or three days by giving 
it a drop or two of brandy, with or without a drop of 
aromatic spirit of ammonia, in a teaspoonful of warm 
water once in two hours. 

Period of Incubation. — The length of time a pre- 
mature baby should be kept in its close quarters is de- 
pendent upon the progress it makes, or until the gain 
in weight and strength brings it up, as nearly as possible, 
to the standard of a baby at full term. A seven-months' 
child, if strong enough, may be dressed and allowed to 
nurse when it is four weeks old. Great care, however, 
must continue to be exercised until the child reaches 
full term. It should not be removed permanently until 
it has acquired sufficient vigor to live in the ordinary 
atmosphere of the apartment. To accustom the child 
to this atmosphere, it should, as it grows stronger, be 
removed for an hour at a time from the couveuse during 
the warmest part of the day. 

It is best to continue the use of the apparatus at night 
for some time after the child becomes accustomed by day 
to removal from the couveuse, for the danger of chilling 
from changes in the atmosphere is greater at night. 

The skin of a premature baby should be well greased 
after every bath, or some oil, as cotton or sweet oil, may 
be used, and will serve the double purpose of protecting 
the skin and giving nourishment by absorption. 

The child should be fed every hour. As it is usually 
too weak to suck, it is safer to feed the baby with a 



THE AILMENTS OF EARLY INFANCY. 227 

spoon or with a dropper, to make sure of its obtaining a 
sufficient amount of food. From one to two teaspoonfuls 
should be given every hour. Breast milk is, of course, 
the best. It may be drawn from the mother's breast and 
fed to the child while warm. The nurse should intro- 
duce her little finger into the child's mouth and allow 
the milk to trickle slowly down the finger, so as to enter 
the mouth drop by drop, while the child sucks the finger. 
Should the mother have no milk, the first week's feeding 
recommended by Dr. Starr, or sterilized peptonized milk, 
diluted two-thirds with boiled and filtered water, may be 
used — if no wet-nurse can be had as a substitute. 

Gavage. — Should the baby drink badly and throw up 
a large proportion of the liquid given to it, " gavage " 
may have to be resorted to. The physician must 
authorize the nurse to carry this out, for she should 
never undertake it otherwise. The directions for prac- 
ticing gavage, as given by Dr. Louis Starr, are as 
follows :— 

The apparatus used is quite simple, being nothing 
more than a urethral catheter of red rubber (Nos. 14-16, 
French), at the open end of which a small glass funnel 
is adjusted. The infant upon whom gavage is to be 
practised is placed on the operator's knee, with its head 
slightly raised; the catheter, being wet, is introduced as 
far as the base of the tongue, whence, by the instinctive 
efforts at swallowing, it is carried as far down as the eso- 
phagus (or gullet) and into the stomach. 

The liquid food is next poured into the funnel, and by 



228 OBSTETRIC NURSING. 

its weight soon finds its way into the stomach. After a 
few seconds the catheter must be removed, and here is 
the great point in the operation ; it must be removed 
with a rapid motion and at once, for if it be withdrawn 
slowly all the food introduced will be vomited. 

Mothers' milk is the best for gavage, as at any time, 
but other kinds of food may be used. The amount given 
and the number of meals will vary with the age and 
strength of the child. From a teaspoonful to a dessert- 
spoonful at one time is sufficient for a very young child, 
given every hour. Too much food would produce indi- 
gestion. As the child grows stronger this mode of feed- 
ing may be made to alternate with nursing. Modified 
cow's milk may be used for the alternate feedings. 

Colic is a very troublesome affection of infancy. It 
corresponds to the dyspepsia of grown people, and indi- 
cates that the food is either improper in quality or quan- 
tity. A colicky cry is a sudden, sharp cry, the baby 
drawing up its feet and legs at the same time. The feet 
are generally cold, and one indication for treatment is to 
warm them ; warm socks or woolen stockings should be 
worn, or hot bottles applied to the feet. 

The abdomen should also be kept warm by the appli- 
cation of heated flannels, or a spice poultice, wrung out 
in hot whiskey, or a flaxseed poultice, which should be 
kept applied until the baby gets relief. 

To make a spice plaster, a teaspoonful each of ground 
allspice, cloves, cinnamon, ginger, and cayenne pepper, 
with four teaspoonfuls of flaxseed meal, may be quilted 



THE AILMENTS OF EARLY INFANCY. 229 

into a bag of flannel, 4x8 inches, which will fit entirely 
over the baby's abdomen. When the spicy smell is lost 
the plaster is no longer good for use. 

Warm oil rubbed gently in over the abdomen for ten 
to fifteen minutes at a time will often give relief by lead- 
ing to the expulsion of the wind causing the pain. 

If the application of heat is not sufficient, anise-seed 
tea should be given. It is made as follows : — 

Over a half-teaspoonful of anise-seed pour a half- 
teacupful of boiling water. Allow it to steep a few 
minutes, until the water tastes strongly of the anise- 
seed. A half-teaspoonful of this may be given warm 
every ten minutes until the baby has had four doses. 
This brings up wind from the stomach, and thus gives 
relief. Simple hot water will help in the same way 
should anise-seed not be on hand. Catnip tea may 
be made and used according to the same directions. 
These teas are preferred to the drop doses of gin so 
frequently given. 

Bowel Movements. — Frequent stools do not always 
indicate diarrhea. For the first six weeks of its life a 
child averages three or four movements every twenty- 
four hours, after which it has about two a day until it is 
two years old. 

A natural passage for an infant would be of a mushy 
consistency and a yellow or orange color. It should 
contain no curds. Bottle-fed babies have whiter and 
more offensive stools than breast-fed babies. 

Diarrhea. — In diarrhea there is a change in consist- 



23O OBSTETRIC NURSING. 

ence or appearance. A liquid stool, or one colored 
green or white or like putty, would be abnormal. The 
presence of curds also would show an inability to digest 
the food properly. The diarrheas of infancy, though 
oftenest due to improper food, may be caused by expo- 
sure to heat, or may result from taking cold. Bottle- 
fed babies suffer much with diarrhea in summer time, 
indigestion and heat acting together to produce the dis- 
ease. Often little can be accomplished without entire 
change of air. A trip to the seashore or the mountains 
has saved many a baby's life. 

In simple diarrhea there is little, sometimes no, fever. 
There may or may not be vomiting. In cholera infantum 
the stools are very numerous, the discharges being the 
color of rice-water. There is constant vomiting, high 
fever, intense thirst, great coldness of the surface, and 
often sudden collapse. 

In inflammation of the dowels the movements are smaller 
and have some color. The fever is more moderate and 
the vomiting is less. 

In dysentery the passages are frequent, small, and con- 
tain more mucus. There is much straining and often 
quite a large amount of blood passed. The emaciation 
of infants suffering from these diseases is very rapid. 

The careful regulation of the baby's diet is the most 
important consideration in treatment. At first all food 
must be stopped for five or six hours. A little barley- 
water or egg-albumen water, or some simple meat juice 
may be used if the baby seems hungry. Cold water 



THE AILMENTS OF EARLY INFANCY. 23 1 

also may be given. If the baby's skin feels hot, it may 
be bathed or sponged with cool water frequently. If 
the surface is cold, a tepid mustard bath may be given. 
When the attack first begins it is well to clear the bowel 
of all irritating substances by a dose of sweet oil, to 
which (for an infant under two months) 1 5 drops of castor 
oil may be added. After this a little bismuth and chalk 
mixture is usually given by the physician, or small pow- 
ders containing bismuth (about I gr.), once in two or 
three hours. The physician will usually determine the 
special remedy indicated after careful inspection of the 
stools. 

Feeding in Indigestion. — If, therefore, curds exist in 
the stools, or the matters vomited be curdy, the indica- 
tion would be to use some alkali or a small quantity of 
some thickening substance, as barley-water, or gelatin, 
or the milk may be peptonized. 

Lime-water is the alkali most usually employed. 
Lime-water contains but about half a grain of lime to 
the fluidounce of water, so that at least a third of the 
feeding should be lime-water where it is used to correct 
indigestion. To make lime-water, a piece of lime about 
the size of the fist should be placed in an earthen vessel ; 
about three or four quarts of water may be poured over 
this, strained thoroughly, and then allowed to settle. The 
water should be used only from the top of the vessel. 
It is better to filter it before use. The vessel may be 
kept filled with water so long as any of the lime remains 
in it, when dissolved it will be necessary to add more 
lime. 



232 OBSTETRIC NURSING. 

When lime-water cannot be obtained, a small powder 
of baking soda — three or four grains — may be added to 
the nursing-bottle. These rules apply when the baby is 
artificially fed. Should the baby be nursing from the 
breast, a teaspoonful of lime-water mixed with an equal 
quantity of boiled and filtered water may be given it 
before it is put to the breast each time. 

Barley- Water and Oatmeal- Water. — Of the thick- 
ening substances used to help in the digestion of food 
barley-water is one of the best. To make barley-water, 
a gill of boiling water should be poured over a teaspoon- 
ful of washed pearl barley, finely ground in a coffee- 
mill. Boil for a quarter of an hour, then strain. It 
should be mixed with milk in the proportions required, 
two-thirds, a half, or one-third. A pinch of salt should be 
added to the mixture. Oatmeal-water is similarly made. 

Gelatin is sometimes used instead of barley-water. 
A piece an inch square of plate gelatin is put into a half 
tumblerful of cold water and allowed to stand about 
three hours. This may then be turned into a teacup 
and set in a pan of hot water and boiled. The gelatin 
thus dissolves, and when allowed to cool forms a jelly, of 
which one or two teaspoonfuls may be added to a feeding. 

Infants' Foods. — Of the various kinds of ''infants' 
food," those in which the starch has been made into 
dextrine or grape sugar are the best. "Mellin's Food," 
" Horlick's Food," and "Eskay's Food" belong to this 
class. A teaspoonful of any of these dissolved in a little 
hot water — about a tablespoonful — may be added to the 



THE AILMENTS OF EARLY INFANCY. 233 

milk for the feeding. Special directions for the use of 
each are supplied by the manufacturers with packages 
of the food. These starch foods cannot be well borne 
by a child before it is five or six months old, as a rule, 
because the secretion of saliva is necessary to the diges- 
tion of starch.* 

Condensed Milk contains a large proportion of sugar, 
hence tends to make fat. It is not so nourishing as 
many other forms of food. Babies fed on it, though 
large, are generally far from strong, and are very apt to 
suffer from indigestion. 

Usage in Woman's Hospital. — A careful regulation 
of the diet for the early weeks of infancy, with the 
addition of barley-water, lime-water, or gelatin, as in- 
dicated, in place of plain water, has been found most 
satisfactory in the care of infants in the Woman's 
Hospital. The use of water alone as a diluent is 
preferred. The modified milk preparations of the 
Walker-Gordon laboratory in Philadelphia have also 
been used with great satisfaction. 

When curds are persistently found in the stools, espe- 
cially with older children, it is thought by some to be of 
advantage to slightly thicken the milk by the addition of 
a little prepared wheat flour, barley, oatmeal, or Graham 
flour. The use of cereals for the purpose, however, is 
rather questionable, especially with young infants. 

* The prepared foods are not to be especially recommended, notwith- 
standing their efficacy in certain cases. Made by the quantity, their com- 
position is of necessity often uncertain, and they must frequently be stale as 
obtained for use. 



234 OBSTETRIC NURSING. 

Flour Ball. — In using wheat the following recipe 
may be employed : [Tie a pint of dry wheat flour into a 
piece of stout muslin and boil nine hours; scrape off the 
outer crust and the inside will be found to be a dry ball ; 
grate this as needed and add about two teaspoonfuls to 
a pint of water, which when boiled may be used in dilut- 
ing the child's milk in the proportion desired, instead of 
using plain water.] After the sixth month, four tea- 
spoonfuls may be used in place of two. Dr. J. Lewis 
Smith recommends allowing the flour, tightly tied up 
in a bag, to stand under water for about a week, the 
water being allowed occasionally to boil during this time. 
The flour is thus rendered more digestible. 

Other Cereals. — Ground barley, oatmeal, or Graham 
flour may be boiled in water in the proportion of a des- 
sertspoonful to the pint. An equal quantity of milk 
may be poured in while the water is boiling, and the 
whole may be boiled together from about twenty minutes 
to a half-hour and then strained. A pinch of salt should 
always be added. An ounce of cream and a little milk 
sugar may be added to this. Dr. Keating recommends 
this preparation as excellent for an infant after its fourth 
month, when he considers that it is best to make the 
use of the bottle alternate with the breast in the feeding 
of an infant, especially if the mother is not very strong. 

Weaning. — If the mother has substituted the bottle 
for some of the feedings as early as at the age of six 
months, the child will not suffer from the. process of 
weaning. In fact, a child often weans itself, refusing to 



THE AILMENTS OF EARLY INFANCY. 235 

take the breast milk during the later months. The 
mother's milk, even in most favorable cases, is rarely 
sufficient nourishment for the child after it is & year old. 
If possible, no change in the child's food should be 
made in the summer months. 

Substitutes for Milk. — When the child is very weak 
and vomits constantly, — milk, especially, seeming to dis- 
agree with it, — some of the following measures may be 
resorted to: small and repeated quantities of barley- 
water, gum-arabic water, or wine-whey may be used, a 
teaspoonful every half-hour or hour; sometimes the 
white of an egg may be shaken up in a bottle of warm 
water and a couple of grains of lactopeptin or Fairchild's 
liquor pancreaticus may be added, with a little milk 
sugar, and this may be given the child in teaspoonful 
doses. As the child's stomach grows stronger, tea- 
spoonful doses of peptonized milk may be tolerated. No 
child should be fed too continuously on the prepared 
foods alone. Fresh milk should be used whenever possi- 
ble, as a disease known as scurvy often arises from long 
use of stale preparations. The admixture of cream 
with water (i part to 5 or 6 of water) has already 
been referred to as a substitute when milk is not well 
borne. 

An occasional drink of water is essential to a baby, 
however young. The water should be boiled and kept 
air-tight to be free from germs. From a teaspoonful 
to a tablespoonful may be given occasionally during 
the intervals of nursing. Infants under four months 



236 OBSTETRIC NURSING. 

of age should be fed upon milk alone in some of its 
forms. 

Milk Foods. — When breast milk cannot be had and 
cow's milk seems persistently to disagree, some of the 
" milk foods," as Carnrick's Soluble Food, Anglo-Swiss, 
Gerber's, or American Swiss, should be tried first before 
any preparation containing starch is used. Care must 
be taken to see that the preparations are fresh before 
using. 

The Farinaceous Foods, as Blair's Wheat, HubbelFs 
Wheat, Imperial Granum, and the home-made prepara- 
tions before described should not be used until the child 
is at least four months old, if at all. 

Liebig Foods. — If in the use of farinaceous food the 
child's bowels become constipated, or it suffers from 
colic, or is restless at night and loses its appetite, some of 
the Liebig foods may be tried, as Mellin's Malted Milk, 
Lactated Food, etc. The directions for the use of these 
foods come with the various packages containing them, 
and are readily followed. Milk, as a rule, in some form 
or other, should be used in making up these prepara- 
tions ; otherwise they will not contain sufficient nourish- 
ment. 

Constipation is not an infrequent occurrence in in- 
fancy. Its management consists principally in the use 
of mechanical irritants for stimulating the bowels; thus, 
a soap suppository, an injection of warm oil or water, 
gentle friction over the bowel, especially following the 
direction of the large bowel from right to left, are among 



THE AILMENTS OF EARLY INFANCY. 



237 



the most effective methods for overcoming this con- 
dition. 

The soap suppository is made by taking a piece of 
Castile soap, about one inch long, and shaping it into a 
cone and making it very smooth, so that it will not be 
larger around than the end of the little finger. This 
should be gentlv insinuated about half 
its length into the bowel and held in 
the opening until it excites the bowel 
to act. 

The bozvel injection may be given 
by means of the single-bulb syringe, 
known as the " eye and ear syringe." 
The bulb holds about two tablespoon- 
fuls of liquid. This may be warm 
cotton-seed oil, sweet oil, or warm 
water. The nozzle used should be 
small, smooth, and well oiled. It 
should be very carefully introduced 
into the bowel, being directed a little 
to the left side, and the bulb gently 
squeezed to force the contents into 
the bowel. It is best that the liquid 
should be retained for a little time before it is forced out. 
The keeping up of a slight pressure over the entrance 
to the bowel for a short time will aid this. 

Rubbing the abdomen for about ten minutes (either 
with or without oil) in the direction of the large bowel — 
that is, upward on the right side as far as the border of 




Fig. 41.— Single-bulb 
Syringe.— {Starr.) 



238 OBSTETRIC NURSING. 

the ribs, then across to the left side and down this side 
to the pelvis, is often efficient in overcoming consti- 
pation. 

Of medicinal measures, glycerin, gluten, or cacao-butter 
suppositories may be resorted to, or manna may be 
given; a piece the size of a pea in the child's milk one, 
two, or three times a day, or a spoonful of water sweet- 
ened with dark-brown sugar. Should the child be fed 
on artificial food, oatmeal water may be substituted for 
barley-water in the preparation of the food. If nursing, 
oatmeal water may be given it (1 tablespoonful) before 
each nursing. 

Rupture, or Hernia, is a protrusion of the bowel 
through some weak point in the abdominal walls. It 
very often occurs at the navel and sometimes in the 
groin. The best treatment for the former consists in 
drawing together the edges of the hernial opening by 
means of a strip of adhesive plaster. A truss will need 
to be fitted for the other form. 

Vomiting. — Babies vomit very easily, because their 
stomachs are placed more vertically in the body than 
when they grow older, and overfeeding will cause them 
to bring up the amount in excess of what the stomach 
can hold. This vomiting is, of course, not serious. 
Should the vomited matter be sour and curdy, the child 
seem to suffer from nausea, weakness, or fever, it indi- 
cates a condition of indigestion which should receive 
attention. The management would largely consist in 
the regulation of the quality and the quantity of the food, 



THE AILMENTS OF EARLY INFANCY. 239 

as has just been said. It is best to withhold food for 
several hours, and modify its character when it is re- 
sumed, as described above. A spice-plaster over the 
stomach is often helpful. When the vomiting is due to 
overeating, the amount of food taken at one time must 
be regulated. 

Worms. — There are three different kinds of worms 
which may exist in children, but young infants are 
troubled, as a rule, with but one kind, the thread or seat- 
worm. These look like little pieces of white cotton 
thread, and the stools should be carefully examined when 
suspected. They make the parts around the lower bowel 
very sore and produce intense itching. The parts should 
be kept very carefully cleansed, and a bowel injection of 
salt and water or of a little infusion of quassia may be 
given every day or so. 

The tape-worm and round worm are found in older 
children. 

Thrush is a disease due to want of care of the baby's 
mouth. If milk be allowed to collect on the tongue, it 
sours, and the presence of this acid favors the develop- 
ment of thrush, which is really a vegetable parasite. 
White patches may be seen on the soft palate, inside the 
cheeks, lips, and tongue. The attempt to rub off these 
patches causes bleeding. Gastric catarrh and diarrhea 
usually accompany this trouble. Care in cleansing the 
child's mouth after each nursing will prevent the occur- 
rence of thrush. Its treatment consists in the use of an 
alkaline wash, as borax and water (twenty grains to the 



24O OBSTETRIC NURSING. 

ounce), or some antiseptic wash prescribed by the phy- 
sician.* 

Birth Marks — that is, the purplish-red patches or 
the moles sometimes found on a new-born baby — are not 
dependent in any way on the mental impressions of the 
mother. They can often be removed by treatment. 

Red Gum is an eruption which comes out over the 
baby in the first or second week of its life. Sometimes 
these little points of elevation on the skin are white. The 
eruption is then called " white gum." These eruptions 
are due to changes in the skin and irritation from ex- 
posure to air, and are not serious. They rarely last over 
a week, although they may persist for several weeks in 
babies of delicate skin or poor digestive powers. They 
are also known as strophulus. 

Blisters. — The occurrence of little blisters on the 
child's body, especially on the palms of the hands and 
soles of the feet, is a matter of more moment and should 
at once be brought to the attention of the physician, as 
also should sores around the finger nails. These indicate 
a condition of the blood for which the use of remedies 
prescribed by the physician will be necessary. The 
technical name for the rash is pemphigus. 

Prickly Heat, or Miliaria, consists of pin-head sized, 



* Boric acid (ten grains to the ounce of water) is very good. A tea- 
spoonful of this may be swallowed by the child occasionally. Of late a 
solution one part hydrogen dioxide to eight of water has been much used. 
This followed by the boric- acid wash. After which a little bismuth sub- 
nitrate may be applied over the sore spots. 



THE AILMENTS OF EARLY INFANCY. 24I 

red elevations closely crowded over the portions of the 
body where there is most perspiration. It often results 
when children are too warmly dressed, or in hot weather. 
The treatment consists in the substitution of lighter 
clothing, with the relief of the skin irritation by the use 
of some powder, as camphor, one part to eight parts 
powdered starch. A little magnesium may be given by 
mouth. 

Stomach Rash is a name given to an eruption known 
as erythema — a redness of the skin, with the occurrence 
of pimples — caused by indigestion. 

Eczema is a disease which is much more troublesome. 
It may last months. There is usually an inherited tend- 
ency to some constitutional trouble; or improper food 
(especially starchy foods) or imperfect hygiene may be 
responsible for it. The surface is swollen, red, and 
moist ; thick crusts often form. There is intense itch- 
ing. Such cases should always be under the care of 
a physician. A saturated solution of salicylic acid, with 
the subsequent application of zinc ointment, often greatly 
relieves the distressing symptoms, and in time removes 
the rash. 

Milk Crust consists of large, yellowish patches on 
the head, and is really dandruff. Castor-oil should be 
used to remove the patches, and this head kept cleansed 
with borax and water. 

The Whites. — Sometimes a whitish, glairy discharge 

comes from the privates of little girl babies. This is 

simply the matter found there at birth. Occasionally 
16 



242 OBSTETRIC NURSING. 

a little blood may be mixed with it, the result of an 
abrasion in the vagina, and may last a day or two. The 
nurse need not be afraid to remove this matter; in fact, 
if left, it causes irritation of the skin. 

Suppression of Urine.— A healthy baby usually wets 
its napkin very frequently — it may be every hour during 
the day, and four or five times at night. Sometimes 
several hours may pass and yet the napkin remain dry. 
Either of these conditions may exist in health, being 
dependent largely upon the weather, the food, etc. If 
urine is not passed for twelve hours, the condition should 
be reported. 

The nurse may try to make the baby urinate by using 
fomentations over the bladder and kidneys before report- 
ing the matter to the physician. If a baby cries when 
urinating, a careful examination must be made of the 
water-passage to see whether there is any cause for irri- 
tation, as the urine may be irritating. In boy babies 
there is sometimes a very long narrow foreskin which 
tends to become adherent to the parts beneath it. 

Phimosis is the name given this condition. For its 
management a nurse should be taught to retract the 
foreskin daily, oiling the surface beneath with a little 
castor-oil applied with a camel's hair brush or stick 
twisted with cotton. For irritating urine, giving the 
baby frequently a drink of cold water is usually sufficient. 

Charing. — The skin of new-born babies is soft and 
thin, and apt to become sore, especially when two sur- 
faces rub. First, a little crack is noticed, next day this 



THE AILMENTS OF EARLY INFANCY. 243 

will have widened until, sometimes, a large surface is 
left bare. To prevent this, proper care of the baby from 
the very beginning is important. Never use soap. Use 
warm water in washing it, either plain warm water or 
water with sufficient powdered borax in it to make it 
soft, and wash the part very carefully ; wipe or mop with 
a soft cloth until thoroughly dry. Then, to prevent fur- 
ther rubbing, carry a piece of dry sterilized gauze into 
the crease between the rubbed surfaces, separating them. 
This should be changed whenever the baby's napkin 
requires changing. 

When the skin is broken, some healing ointment is 
generally required. The following has proved very 
satisfactory : An ointment consisting of two drams of 
bismuth subnitrate to the ounce of zinc ointment, or, 
preferably, lanolin. A paste of equal parts of bismuth 
subnitrate and castor-oil is also useful for the purpose. 

Boils. — When run down or suffering from chronic 
digestive troubles, babies often suffer from boils or other 
pustular eruptions. They may arise, too, from conditions 
of constitutional disease. When these need to be poul- 
ticed, the only kind of poultice admissible is an antiseptic 
poultice made by wringing out several folds of clean, soft 
linen or gauze in a hot saturated solution of boric acid and 
covering this with a piece of rubber tissue or paraffin 
paper to retain the heat. A little ointment containing 
ichthyol is good in the early stage. When pus exists, 
the boil should be lanced. Change of air with tonics 
will often do much to relieve this tendency. 



244 OBSTETRIC NURSING. 

Fever Blisters. — Children should be kept from pick- 
ing these blisters, which may be treated by the applica- 
tion two or three times a day of the bismuth and zinc 
ointment or any healing ointment. 

Itch is a contagious skin affection, usually found 
among the dirty, but may be contracted by the cleanest 
children. The sides of the fingers, the toes, the buttocks, 
may be covered with small pimples and irregular ridges 
where the parasite has burrowed. There is intense itch- 
ing. The thorough and careful use of antiseptics under 
the direction of a physician will be necessary for cure. 

Ringworm is also a contagious skin affection due to 
a fungous growth. The ring-like shape gives it its 
name. Sulphur and tar ointment make a good applica- 
tion for this. Ringworm of the scalp is very difficult to 
cure, and should be seen by a doctor. 

Baby's Sore Eyes generally come about from some 
infection of the eyes through the mother's discharges at 
the time of the birth, or in lying-in hospitals one baby 
infects another. Hence, care should be taken to cleanse 
the eyes immediately after the delivery with a saturated 
solution of boric acid, or even clean, warm water, they 
may be prevented, as a rule, from getting sore. In many 
hospitals a drop of a two per cent, solution of nitrate of 
silver is dropped into the eyes after douching them well 
with boiled water at 98 F. Should the inflammation 
occur, however, the nurse must remember that the affec- 
tion is contagious, through the matter which forms in 
the eye. This matter is capable of setting up an inflam- 



THE AILMENTS OF EARLY INFANCY. 245 

mation elsewhere, as when a towel used about the eves 
may produce a similar inflammation about the privates ; 
a scratch or wound on the hands may be affected by it. 
The discharge from affected eyes is greenish-white. The 
poison it contains is not destroyed by drying ; it catches 
and clings to the room, as the poison of smallpox. 
Hence, a nurse's hands should be thoroughly cleansed 
after washing the eyes, and the nails cleaned with a nail- 
brush. The cloths used in washing the eyes should be 
burned at once after using. The greatest precautions 
must be taken not to carry the poison. The nurse's chief 
care, apart from preventing the spread of the trouble, 
in such a case, would be to keep the eye or eyes free 
of the discharge by frequent cleansings with warm water 
gently syringed into the eye from the inner toward the 
outer angle, the lids being held everted by their gentle 
separation by the thumb and finger of one hand.* This 
washing may need to be done every hour. The baby's 
hands should be kept down by fastening a towel around 
the child's body, pinning it in the back. The baby may 
be held between the nurse's knees and its head inclined 
over a basin, which will receive the water from the 
washing. Another basin should contain the clear water 
to be used. Should only one eye be sore, in placing the 
baby in its crib, or laying it down at any time, the nurse 
should be careful to place it with the sore eye down, so 
that any discharge from it may not enter the other eye. 

* A warm saturated solution of boric acid is even more efficacious. 



246 OBSTETRIC NURSING. 

Any further irritation, as of a strong light, should be 
prevented by keeping the baby in a darkened place. 
Want of attention in these cases may cause a child the 
loss of its sight. A room occupied by a baby with sore 
eyes must afterward be carefully disinfected. When the 
eyes are inflamed, the application of ice-cloths every two 
or three minutes, kept up persistently until the inflam- 
mation subsides, is most efficacious. A piece of ice with 
small squares of linen laid upon it can be kept at the side 
of the crib so as to be ready for constant use. The 
cloths removed should be burned. 

There is a law in many States, Pennsylvania included, 
requiring nurses or mothers having an infant in charge 
who is not under the care of a medical attendant to re- 
port promptly to the Board of Health any appearance of 
inflammation about the eyes. 

Snuffles, or a Cold in the Head, shown by watery 
eyes, sneezing, stopping up of the nose, hence difficulty 
in nursing, should be managed by keeping the nose 
cleaned out by means of soft linen twisted into a cone, 
greasing the nose well afterward with a little oil by carry- 
ing it up the nostrils on a twist of cotton, greasing the 
outside of the nose between the eyes, and keeping the 
baby warm. If the baby has no hair, the head may be 
kept warm by a little mull (or in winter thin flannel) cap. 
Sometimes a little niter water or some tonic may be 
required. 

Running at the Ears is generally very serious in 
new-born babies, especially when the discharge is matter 



THE AILMENTS OF EARLY INFANCY. 247 

or blood. Some trouble with the brain may be threat- 
ened, hence the physician should be told of it as soon as 
it is noticed. Of course, the discharge entering the ears 
at the time of the birth should be carefully excluded 
from this disorder. 

Earache. — A persistent cry, with the raising of the 
hand constantly to the head, will often indicate earache. 
No medicine should be dropped into the ear and no 
poultice placed over it. The pain is often relieved by 
holding a hot water bag or bottle to the ear. Relief is 
also often obtained by syringing the ear with water as 
hot as can be borne. This should be done frequently, and 
the ear kept covered in the intervals with hot, dry flannel. 

The Breasts of new-born babies often swell. Gen- 
erally this occurs about the seventh day or during the 
second week. Occasionally they gather, and must then 
be lanced by the physician. Nothing should be done 
for this swelling, except to see that the clothing is loose. 
It disappears in a few days, as a rule. 

Scalp Tumors. — The same may be said of swellings 
on the head or about the face, which are due to pressure 
during the birth. One form of scalp tumor may last 
several weeks before its entire disappearance. The latter 
is the result of temporary injury to the bone, and not 
simply the ordinary swelling which comes from inter- 
ference with the circulation of the blood in the soft tis- 
sues of this portion of the scalp. The name blood-tumor 
(hematoma) is applied to this. No active treatment for 
its removal is necessary. 



248 OBSTETRIC NURSING. 

Deformities. — A child may be born with some de- 
formity, as hare-lip, or cleft-palate, or club-foot, or 
extra fingers and toes, or there may be some malfor- 
mation about the external organs of generation or 
the bowel. The bowel passage may be closed, or there 
may be no opening from the bladder. Whatever the 
deformity may be, the nurse should avoid letting the 
mother know anything about it until the physician has 
told her of it. The shock produced by the knowledge 
may do the mother much injury; hence the physician 
should bear the responsibility of making the announce- 
ment. A nurse will need considerable tact in man- 
aging this, as the mother is apt to ask to see her baby 
very soon after its birth. An excuse may be made by 
stating the necessity for washing and dressing the child 
first, or it may be asleep and the nurse hesitate to disturb 
it. A child with hare-lip or cleft-palate will need to be 
fed, as a rule, with the spoon or a dropper, as it cannot 
nurse. 

Tongue-tie. — Quite frequently the bridle beneath the 
baby's tongue is too short, and interferes with the free 
movement of the tongue. This is called " tongue-tie." It 
may prevent the child's nursing, and thus interfere with 
its nutrition. If the baby can extend the tip of the 
tongue beyond its lips, it is not probable that there will 
need to be anything done, as the baby ought to be able 
to suck a good nipple with ease. If the nurse should 
introduce the tip of her little finger into the baby's 
mouth and allow the child to draw on it for a few 



THE AILMENTS OF EARLY INFANCY. 249 

minutes, she can tell whether the act of sucking can be 
properly accomplished. Should it not be able to suck, 
the attention of the physician should be called to the 
matter, as the bridle will have to be nicked- — an opera- 
tion following which there may be considerable loss of 
blood, hence it should not be attempted except by a 
physician. 

Bleeding from the Cord or navel string may occur 
within a few hours after birth. It may be that the cord 
has not been tied sufficiently tight, or there may have 
been a very thick cord, which, in shrinking, has loosened 
the ligature. If, after tying, the cord has been looped 
back upon itself and tied in a single double bow-knot, 
this may be untied by the nurse and fastened more 
tightly, so that the bleeding may be controlled, or an- 
other ligature may be thrown around the cord a little 
nearer the body of the child than the first one. Should 
this not check the hemorrhage, the nurse should hold 
the cord firmly between the thumb and finger, making 
compressions until the physician, who should be sent 
for, arrives.* 

Falling of Cord. — The cord commonly falls off about 
the fifth day. The process of ulceration, by which it 

* Bleeding from the base of the stump after the cord has fallen is a 
more difficult condition to manage. The physician needs sometimes to 
control the hemorrhage by a ligature drawn beneath transfixion pins. The 
nurse must keep up pressure over the site until the doctor comes. If this 
is a simple oozing, a free application of powdered tannic acid with a com- 
press is all that is necessary. 



25O OBSTETRIC NURSING. 

falls off, leaves an open surface on the child's body 
which offers an avenue for septic infection. Great care 
should therefore be taken that the nurse's hands and any- 
thing else that comes in contact with this surface are 
perfectly clean. Should any moisture exist about the 
stump, the use of the antiseptic powder of salicylic acid 
and starch, before spoken of, or some other drying pow- 
der of the kind, may prove useful. It is necessary, also, 
to see that the dressing used is thoroughly antiseptic. 
When infection does exist, it shows itself in the occur- 
rence of inflammation around the navel or some other 
part of the body ; the child loses flesh, has fever, be- 
comes puny and emaciated, and abscesses form in va- 
rious places. In the majority of cases it dies, not having 
sufficient vitality to survive the poisoning.* 

The physician will, of course, prescribe the treatment 
for such a child; the nurse will be required to see that 
these directions are faithfully carried out, and especially 
that the child gets all the nourishment and stimulation 
required. 

Umbilical Vegetations are either soft, jelly-like 
growths, or, what is more common, hard protuber- 
ances sometimes the size of a hickory-nut. They are 
not painful and seldom bleed. The physician sometimes 
removes them by ligature. The softer forms may be 
touched with caustic and thus made to shrink. When 
an ulcer exists at the place from which the cord dropped, 

* Sometimes the inflammation takes on the character of erysipelas. 



THE AILMENTS OF EARLY INFANCY. 2$l 

dry antiseptic dressings or a drying powder, as boric acid 
and zinc oxide or a little tannic acid powder should be 
kept applied. 

Jaundice. — A peculiar yellowish coloration of the 
skin is to be noticed with babies a few days after the 
birth. This disappears, as a rule, by the end of the 
second week, and is due to changes in the circulation. 

Should the jaundice be very marked and seem to per- 
sist, warm baths once or twice a day, with gentle friction 
over the liver with soap liniment, helps, with free action 
oi" the bowels, to overcome the condition. Jaundice of 
the new-born baby is sometimes the result of disease of 
the liver. The color is then very marked. The baby 
grows thin rapidly and appears sick. The stools are apt 
to be clay-colored. When the child is suffering from 
blood-poisoning, the peculiar coloration of the skin is 
due to this cause. 

Buhl's Disease is an obscure disease of new-born 
babies, thought to be due to fatty degeneration of the 
internal organs. It results fatally, as a rule, within the 
first few days. There is a tendency to hemorrhage from 
various parts of the body. 

Bleeders. — In some families, known as " bleeders," 
the tendency to hemorrhage may be transmitted to the 
child, particularly if it be a boy. It is necessary to 
watch for any such tendency very closely. The hemor- 
rhages may occur from any open surface on the body, 
or from the mucous surfaces. Tarry stools occurring 
after the normal bowel passages have been established 
would be an indication of intestinal hemorrhage. Some- 



252 OBSTETRIC NURSING. 

times the hemorrhage is in the brain and the child dies 
with symptoms of brain trouble. 

Convulsions may occur in very young infants at 
varying periods after their birth, according to the cause 
which excites them, as injury during labor, indigestion, 
brain trouble, or other causes. The convulsive seizure 
is generally preceded by twitching of the limbs, a rolling- 
up of the eyeballs, so that a large part of the whites of 
the eyes is seen, the thumbs are drawn into the palms 
of the hands, and the fingers tightly clasped over them, 
or the toes may be turned upward or drawn downward. 
During the convulsion the child grows rigid. 

When the attack comes on the nurse should quickly 
undress the child and place it in a warm bath. A table- 
spoonful of mustard added to the water will help to 
stimulate the skin, and the convulsion will gradually 
subside. The child, on its removal from the bath, may 
be wrapped in a heated blanket, and allowed to perspire 
freely. On the recurrence of the convulsion, the same 
measure of placing the child in the bath should be re- 
sorted to, until the physician comes and institutes such 
other treatment as he may think proper. The use of an 
ounce of milk of asafetida by bowel is often efficient in 
quieting nervous irritability. 

Bruises, the result of falls or blows, should be treated 
by the repeated application of hot or cold compresses. 
This will relieve pain and prevent swelling and the 
black and blue discoloration of the skin which would 
otherwise result. 



THE AILMENTS OF EARLY INFANCY. 253 

The occurrence of a fall or blow should always be at 
once reported by a nurse, as the child should be carefully 
examined for the discovery of any injury the serious con- 
sequences of which may be averted by prompt treatment. 
The occurrence of paleness or vomiting after any such 
accident is a serious symptom, and should receive imme- 
diate attention by the physician. 

Fever. — A hot, dry skin may accompany various of 
the disorders of infancy, notably inflammatory conditions 
of the digestive organs and of the lungs. The normal 
temperature of a new-born baby is 99 ° Fahr., the pulse 
140, the respiration 44. 

Should the child seem to be ailing, its temperature 
should be taken. A clinical thermometer may be held 
the requisite number of minutes in the groin or in the 
folds of the neck. Some slip the bulb of the thermome- 
ter into the rectum. Should the temperature be raised, 
the pulse rapid, and the respiration hurried and difficult, 
some lung trouble probably exists. Pneumonia is a very 
common disease with infants. A catch in the breath, 
noisy breathing, a distention of the nostrils on taking an 
inspiration, would indicate the same thing. The fre- 
quent rubbing of the chest with some counter-irritant 
liniment, as St. John Long's liniment, the use of the 
cotton-jacket for the protection of the chest, and, if the 
child is very feverish, sponging it frequently with tepid 
water, and the use of a drop of sweet spirits of niter in a 
teaspoonful of cold water once in two hours or oftener, 
will constitute the nurse's management of the case until 



254 OBSTETRIC NURSING. 

the doctor has seen the baby and laid down his plan of 
treatment. The cotton-jacket is made by taking a high- 
necked, long-sleeved merino vest a size or two larger 
than would be needed by the baby for ordinary wear, 
opening it down the front, and fastening tapes an inch 
or two from each edge in front, by which the jacket 
may be closed. The inner surface of this vest, back and 
front, should be quilted with sheep's wool or cotton 
batting, the outer surface with oiled silk or oiled muslin. 
This makes a very warm covering for the chest. Some 
physicians employ compresses wrung out in cold water 
underneath the lined vest, renewing them frequently; 
others prefer using warm flaxseed poultices. 

Infectious Diseases, such as scarlet fever, measles, 
etc., are very rare under the age of one year, especially 
under six months, therefore do not need to be consid- 
ered here. Occasionally when the mother has the affec- 
tion or has been where these diseases are immediately 
before or at the time of the baby's birth, the child will 
have the disease or develop it. The treatment must be 
managed by a physician. 

Cyanosis, or " blue disease," comes from the imper- 
fect closure of an opening which exists in the heart 
before birth. The baby is called a "blue baby," and is 
very delicate in consequence of this imperfection in its 
circulation. Such babies generally die, if not during 
infancy, some time during early childhood. With great 
care they sometimes live, and the opening in the heart 
gradually closes up. The special care required is to 



THE AILMENTS OF EARLY INFANCY. 255 

keep the child warm and to handle it very carefully, so 
that it may be subjected to no jar or nervous fright. 
The child should be kept lying on its right side, or on 
its back, in order that there may be as little interference 
as possible with the action of the heart, and that the 
tendency of the blood to flow through this opening in 
the upper chambers of the heart — from right to left — 
may be overcome. 

Rickets is a disease of the bones — the result of poor 
nutrition. There is not sufficient deposit of earthy 
matter in the bones, hence they remain too soft and are 
subject to all kinds of distortions in consequence of this. 
The child may be bow-legged and is stunted in its 
growth, curvatures of the spine may exist, or an unnatu- 
rally large head, known as hydrocephalus, or " water on 
the brain." 

Scrofula is a term applied to a form of tuberculosis 
common among children. It shows itself in the tend- 
ency to enlargement of the glands, especially of the 
neck — the occurrence of abscesses and sore and weak 
eyes. Such cases should always be under the care of a 
physician. 

Marasmus is a term used to indicate a condition of 
persistent wasting in a child from whatever cause. The 
child becomes excessively thin, the skin yellowish, the 
face wrinkled. Tuberculosis, syphilis, persistent diar- 
rhea, and vomiting are apt to produce it. 

The baby having this disease is very weak, cannot 
hold up its head well, perspires very freely, especially 



256 OBSTETRIC NURSING. 

about the head. The complexion is very white. The 
baby has constant trouble with its bowels, having green 
stools nearly all the time. The opening in the front of 
the head is depressed and the child seems to waste. 

As the baby grows older, unless well cared for, the 
evidences of disease increase, the joints are enlarged, the 
baby cannot support itself on its limbs, its teeth are slow 
in coming, etc. 

The mother can do much for the health of her child, 
while still carrying it, by a careful regard for her own 
general health. After the baby's birth it should t>e kept 
well nourished, to overcome any tendency to disease. 
Salt baths, oil baths, and the use of tonics ordered by the 
physician, as cod-liver oil, together with careful atten- 
tion to the quality and quantity of nourishment, will do 
much to prevent the progress of any wasting disease. 

Water on the Brain, or Hydrocephalus. — An en- 
largement of the head is sometimes found even with very 
young infants, due to an accumulation of fluid within the 
skull, which results from a form of chronic inflammation. 
In mild cases the mind is not affected, and the child 
seems to outgrow the condition. 

Paralysis of one side of the face or of an arm some- 
times results from pressure during the birth. The baby 
usually recovers from this in a few weeks. Another 
form of paralysis sometimes occurs with infants which 
is due to disease of the spinal cord. These cases require 
intelligent medical supervision. 

Vaccination. — The question often arises as to how 



THE AILMENTS OF EARLY INFANCY. 257 

early a baby should be vaccinated, particularly if small- 
pox be prevalent. As a matter of experience, it is found 
that the vaccination does not " take " well before the 
third month, though if a younger baby is to be exposed 
to the poison, it would be well to have it vaccinated. 
Vaccination should be avoided, if possible, when the 
baby's health is run down from any cause, also at the 
time of teething. A peculiar and distressing form of 
rash sometimes occurs, or there is a great deal of inflam- 
mation following the vaccination, leading the parents to 
imagine that the baby has been poisoned by the virus 
used. 

Care should be taken to see that the child does not 
scratch the sore, and that it is kept free from the rub- 
bing of the clothing. No grease should be applied 
unless directed by the physician. When there is much 
redness and intense itching the physician may direct 
some powder or ointment to be applied to allay this. 

A soft, clean, linen handkerchief can be bound over the 
sore, and a loose-sleeved garment used to prevent the 
irritation of rubbing. Applications which are not aseptic, 
when used about such a sore may induce blood-poi- 
soning. 

An insight into the frailty of human life in its earliest 
days proves how much the world owes to the faithful- 
ness of mothers and nurses, and should be a stimulus to 
scientific research in the discovery of improved methods 
for the management of infancy. 
17 



INDEX. 



A. 

Abdominal bandages, 82 

Accidents of labor, 115-133 
of pregnancy, 53 

After-birth, delivery of, 96 
disposal of, 112 
low attachment of, 54 
position for delivery of, i2( 
operative removal of, 127 

After-care of parturient, 128 

After-pains, 159, 160 

Ailments of infancy, 217 

Airing of infant, 204 

Amenorrhea, 24 

Anesthesia, 132, 133 

Antisepsis, 59-65 

Antiseptic dressings, 83-85 

Antiseptics, 67-80 

during labor, 101, 102 
poisoning from, 72 

Artificial breathing, 1 17-125 

Attentions after labor, 112 

Auvard's couveuse, 219, 220 



Baby's basket, 91 

Bag of waters, 94 

Bandages, abdominal, 82 

for breasts, 1 50-156 
for varicose veins, 39-41 

Barley water, 232 

Bathing during lying-in, 141 
pregnancy, 49 

Binder for baby, 87 

for mother, 82 

Birth-marks, 240 

Bladder, 34, 35, 141 
baby's, 213 

Bleeders, 251 

Bleeding from cord, 249 

Blisters, 240 

Boils, 243 

Boston bandage, 155 



Bowel movements, 229 
Breast-pumps, 152 
Breasts, anatomy of, 22 

caked, 150 

care of, during lying-in, 146-159 
pregnancy, 43 

gathered, 156 

of infants, 247 
Breech delivery, 128 
Bruises, 252 
Buhl's disease, 251 

Byrd-Dew method of resuscitation, 118, 
119 



c. 

Caked breasts, 150 

Catheter, 34, 142-144 

Cereals, 233, 234 

Chafing, 242 

Chorea, 51 

Cleansing of infant, 176 

Cleft palate, 248 

Clothing during pregnancy, 44, 49 
for puerpera, 82 
of infant, 87, 91, 176 
of nurse, 98, 99 

Cold in head, 246 

Colic, 228 

Colostrum, 183 

Complications of labor, 51 

of pregnancy, 51 

Conception, 24 

Constipation of infants, 236 

of mother, 32, 33, 144 

Convulsions of infant, 252 

during labor, 130 

pregnancy, 57, 58 

Cord, care of, 249 

Couveuse, 217-225 

Cow's milk, 187 

modified, 189-192 

Cramps during labor, no 

Cream, 190 

Crib, 178, 179 



259 



26o 



INDEX, 



Cries of infant, 211 
Cross-bed, 132, 133 
Cyanosis, 254 



Deformities of infant, 248 
Delivery, position for, 111 
Deportment of nurse, 109, no 
Development of infant, 203 
Diarrhea of infant, 229, 230 
of mother, 33, 34 
Diet after labor, 136, 137 

during pregnancy, 32, 50 

of infants, 181-204 
Disinfection, 66-80 
Dress for nurse, 98, 99 
Drink for baby, 182 
Duties of nurse during labor, 98-114 
Dysentery, 230 
Dysmenorrhea, 24 



E. 

Earache, 247 
Eczema, 241 
Emergencies of labor, n 5-1 33 

of pregnancy, 53-58 
Emotions, maternal, 51 
Epilepsy, 51 
Erythema, 241 
Etherization, 132-133 
Exercise during pregnancy, 51 
Experiments (bacteriolog cal), 63-65 
Expression of infants, 212 
Eyes of new-born, 177, 207, 244-246 



F. 

Falling of cord, 249, 250 

Fallopian tubes, 21, 22 

Farinaceous foods, 236 

Feeding in indigestion, 231-236 
of infants, 181-204 

Fever blisters, 244 

Fevers, 253 

Flour ball, 234 

Fontanelles, 206, 207 

Food after labor, 136, 137 

during pregnancy, 32-50 
of infancy, 181-204, 230-236 

Formaldehyd disinfection, 77, 78 

Formalin, 75, 79 

Formulae for infant feeding, 195-197 

Fractional sterilization, 191 

Fresh air for infants, 204 



Galactagogues, 185 
Galactorrhea, 159 
Garrigues bandage, 150, 151 
Gavage, 227, 228 
Gelatin, 232 
Germs, 59-65 
Gertrude suit, 90 



H. 

Hair, baby's, 177, 207 

Hand feeding, 187-204, 230-236 

Hare-lip, 248 

Hearing of infants, 207 

Heart trouble, 254 

Hematoma of scalp, 247 

Hemorrhage during labor 



29, 130 
pregnancy, 53-55 



Hemorrhoids, 39 
Hernia in infants, 238 
Human milk, 183 



I. 



Infants' foods, 181-204, 230-336 
Inflammation of bowels, 230 
Injections for infants, 237 

for mother, 100, 10 1 
Insanity, 51, 166-168 
Involution, 168 
Itch, 244 



J- 

Jaundice, 251 

Jenness Miller clothing, 44-49 



Kidneys, 35-38 



K. 



L. 



Labor, preparations for, 81-91 

signs of, 91-93 

stages of, 93-97 
Laborde's method of resuscitation, 124 
Lactation, 183 
Lactometer, 185, 186 
Leucorrhea, 38 
Liebig foods, 236 
Lime water, 231 



INDEX. 



26l 



Lion incubator, 221-223 
Lochia, 139 
Lying-in, 134-170 



M. 



Marasmus, 255 

Marshall Hall method of resuscitation, 

125 
Meconium, 175, 176 
Mellin's food, 236 
Menorrhagia, 24 

Methods for calculating date of confine- 
ment, 29-31 
for resuscitation, 117-125 
Metrorrhagia, 24 
Miliaria, 240, 241 
Milk analysis, 184 

crust, 241 

foods, 236 

leg, 164, 165 
Miscarriages, 53, 55 
Molding of infant's head, 206 



N. 

Nervous diseases of pregnancy, 51. 

Neuralgia, 41 

New-born, care of, 171-204 

Nightingale wrap, 85 

Nipple protector, 44 

shield, 147 
Nipples, care of, 146 
rubber, 203 
Nursing bottle, 201 



Oatmeal water, 231 
Observation of symptoms, 161 
Operations in obstetrics, 131, 132 
Order-board, 170 
Outfit of baby, 87-91 

of mother, 82-87 
Ovaries, 22 



Pains, false, 93 

of labor, 93, 95, 96 

true, 93 
Paralysis, 256 
Pasteurization, 191, 192 



52 



Pelvis, anatomy of, 17 

contents of, 17, 18 
measurements of, 17 
Peptonized food, 194 
Phimosis, 242 
Piles, 39 

Placenta, 54, 96, 112, 126 
Poisoning, blood, 163, 164 

from antiseptics, 72 
Powder, use of, 173, 174 
Pregnancy, management of, 32-52 

signs of, 25-29 
Premature rupture of membranes, 56 
Prematurity, 217, 218 
Preparation of patient for labor, 100 

of room, 81 
Prickly heat, 240, 241 
Prochownick's method of resuscitation 

123, 124 
Prolapse of cord, 131 
Puerperal fever, 163 
mania, 166 
ulcers, 164 
Pulse in hemorrhage, 129 
in lying-in, 161, 163 
in pregnancy, 28 



Quality food for infants, 188 
Quantity food for infants, 192, 19; 



R. 

Red gum, 240 

Report, 162, 170 

Respiration of infant, 209 

Resuscitation of infant, 117-125 

Rickets, 255 

Ringworm, 244 

Rubber cloth, 85,86 

Rules for feeding infants, 193 
for lying in wards, 67-71 
for management couveuse, 221-223 
for premature infants, 217-228 

Running at ears, 246 

Rupture in infants, 238 

of membranes, 56, 94 
of uterus, 131 



s. 

Salivary glands, 41 

Scalp tumors, 247 

Schultze method of resuscitation, 120-122 



262 



INDEX. 



Scrofula, 255 
Sea voyages, 50 
Senses of infants, 207, 208 
Septic infection, 71 
Sitting up (first), 168, 169 
Skin of infant, 205, 206 
Sleep after labor, 134 
of infants, 209 
Snuffles, 246 
Soap suppository, 237 
Soiled clothing after labor, 135 
Sore eyes, 244-246 

mouth, 211-212 
Spice plaster, 228 
Sponge bath, 172, 173, 178 
Sterilized milk, 191, 198, 200 
Sterilizer, 199 
Stomach of infant, 194 

rash, 241 
Stools of infant, 229 
Sulphur disinfection, 75 
Suppression of urine, 242 
Sylvester method of resuscitation, 125 
Syphilis, 52 
Syringe, 86, 87 



T. 

Tact, no 

Tarnier's couveuse, 218, 219 

Teeth during pregnancy, 42 

of infants, 213,215 
Temperature of infant, 210, 253,254 

of mother, 161, 163 
Thrush, 239 

Toilet, first, of infant, 1 71-173 
Tongue-tie, 248 
Training of infant, 180 



Tub, 79 
Twins, 127 
Tying cord. 



15 



u. 



Umbilical vegetations, 250 

Urinalysis, 36-38 

Urinary organs during pregnancy, 34, 36 

Urination of infants, 212, 213 

Uterus, 21 



Vaccination, 256, 257 

Vagina, 20, 21 

Vernix caseosa, 171, 172 

Visitors, 135 

Vomiting during labor, 109, no 

pregnancy, 42, 43 
of infants, 238, 239 



w. 

Walking of child, 215, 216 
Washing for infants, 135 
for mother, 135 
Weaning, 234, 235 
Weighing of infants, 177 
Weight of infant, 208 
Wet nurse, 182 
" Whites " in infants, 241-242 
Worms, 239 



Y. 



Y-bandage, 155 



Catalogue No. 5. January, 1899 



BOOKS m NURSES. 



FOR NURSES AND ALL ENGAGED 
IN ATTENDANCE UPON THE SICK, 
OR THE CARE OF CHILDREN. 



g® 01 Dealing exclusively in books on medicine 
and collateral subjects, we are able to give special 
attention to supplying books for nurses. We have 
a large stock of works on Nursing, Hygiene, 
Popular Medicine, etc., Temperature Charts, etc. 

Catalogues of Books on Medicine, Dentistry, 
Pharmacy, Chemistry, etc., free, upon application. 

Special attention given to orders to be forwarded 
to a distance, by mail or express. Upon receipt of 
the price, any book will be delivered, free, to any 
address. Money should be forwarded by Post- 
Office Order, Draft, or Registered Letter. 

P. Blakiston's Son & Co., 

1012 WALNUT STREET, PHILADELPHIA. 

4®^ The prices as given in this catalogue are net. 
No discount can be allowed retail purchasers* 



A HANDBOOK OF 

MATERIA MEDICA 

Including Sections on Therapeutics and Toxicology, and 

a very complete Glossary of Terms with 

Dose and use of each Drug 1 . 



SPECIALLY PREPARED FOR TRAINED NURSES. 



BY JOHN E. GROFF, Ph.G., 

Apothecary in the Rhode Island Hospital , Providence. 



235 PAGES. 12M0. HANDSOMELY BOUND IN CLOTH, $1.25. 



*#* In preparing this work the author has endeavored to present 
the extensive subject of Materia Medica in a systematic form, suffi- 
ciently comprehensive to meet the requirements of the trained nurse. 

The work is intended to make the nurse* acquainted with the 
numerous drugs of vegetable and chemic origin, their Latin and 
English names, the parts of the plants used, the names of and some- 
thing about the preparations, the chemicals used as medicines, the 
handling of them, etc. A set of questions follow each chapter, and 
there are many explanatory foot-notes and paragraphs. 

From the Medical Record, New York. 

" It will undoubtedly prove a valuable aid to the nurse in securing a knowl- 
edge of drugs and their uses." 

From Philadelphia Medical Journal. 

" The task of abridging the subject of materia medica for the use of trained 
nurses is far from an easy one, as it is necessary to use good judgment in 
putting in what it would be well and helpful for her to know without leaving out 
the necessary part. Moreover, to arrange the subject in a practical and sys- 
tematic manner for the purpose of teaching and ready reference is a difficult 
matter. The author of this book has succeeded admirably in doing this, and 
the work is sure to be in great demand by nurses." 



HUMPHREY'S 

MANUAL OF NURSING. 

MEDICAL AND SURGICAL. 



A complete Text-Book for NurseSj including General Anatomy 
and Physiology, Management of the Sick-Room, Appliances used 
in Sick-Room, Antiseptic Treatment, Bandaging, Cooking for 
Invalids, etc., etc. 

Sixteenth Edition. With 70 Illustrations. 

BY LAWRENCE HUMPHREY, M.A., M.D. 

12MO. CLOTH. PRICE $1.00. 



St. Joseph's Hospital, 

Seventeenth and Girard Avenue, 

Philadelphia, March 15, 1893. 
Messrs. P. Blakiston, Son <&* Co. .•— 

Please send us six more copies of Manual of Nursing, by Humphrey. We 
do not know of any book that more completely meets the requirements of a 
Training Class than Dr. Humphrey's able Lectures, for they are at once clear, 
concise, and thoroughly practical. Sisters of Charity. 



From British Medical Journal, London. 

" Nursing literature is expanding, and, what is more to the purpose, it shows 
manifold signs of improvement with its growth. In the fullest sense, Dr. 
Humphrey's book is a distinct advance on all previous manuals. It is, in point 
of fact, a concise treatise on medicine and surgery for the beginner, incorporat- 
ing with the text the management of childbed and the hygiene of the sick-room. 
Its value is greatly enhanced by copious wood-cuts and diagrams of the bones 
and internal organs, by many illustrations of the art of bandaging, by tempera- 
ture charts indicative of the course of some of the most characteristic diseases, 
and by a goodly array of sick-room appliances, with which every nurse should 

endeavor to become acquainted The systematic arrangement of 

subjects adopted by the author is excellent." 



THE BEST GENERAL TEXT-BOOK. 



NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 

A Series of Lectures Delivered to the Pupils of the Training School 

for Nurses Connected with the Woman's Hospital of 

Philadelphia, comprising their Regular Course 

of Instruction on such Topics. 

BY ANNA M. FULLERTON, M.D., 

Physician-in- Charge of and Obstetrician and Gynaecologist to the Woman's 
Hospital of Philadelphia, etc. 

SECOND EDITION, REVISED. 

12mo. 300 Pages. 70 Illustrations. Cloth, $1.50. 

*a*The immediate success of Dr. Fullerton's "Handbook of 
Obstetric Nursing," a fourth edition of which has just been pub- 
lished, has encouraged her to prepare this manual on another and 
very important branch of the science and art of nursing. Dr. 
Fullerton has demonstrated that she not only knows what to say, 
but that she has the happy faculty of saying it in a plain, practical 
style that interests as well as instructs. 

Synopsis of Contents. — The Surgical Nurse — The Germ Theory 
of Disease — Asepsis and Antisepsis — Abdominal Section — The Pre- 
paration of the Room — The Preparation of Sponges — Sterilization 
of Instruments, etc. — Preparation of the Patient — Preparation of 
Operator and Assistants — The Nurse's Duties During Operation — 
The Nurse's Duties After Operation and During Convalescence — 
Management of Complications — The Pelvic Organs in Women — 
Diseases of Women — General Nursing in Pelvic Diseases — Pre- 
parations for Gynaecological Examinations— Preparation for Gynae- 
cological Operations — Preparation of Patient, Operator and Assist- 
ants — Duties of Nurse During Operation — Special Nursing in 
Gynaecological Operations — Diet for the Sick — Supporting Treat 
ment of Abdominal Sections — Index, 



A HANDBOOK 



OBSTETRIC NURSING. 

Comprising the Course of Instruction in Obstetric Nursing 

given to the Pupils of the Training School for Nurses 

connected with the Woman's Hospital of Philadelphia. 

BY ANNA M. FULLERTON. M.D., 

Demonstrator of Obstetrics in the Woman' s Medical College of Pennsyl- 
vania; Fhysician-in- Charge and Obstetrician and Gynecologist to the 
Woman s Hospital of Philadelphia, and Superintendent of the 
Nurse Training School of the Woman' s Hospital of Philadelphia. 

40 Illustrations. 12mo. Handsome Cloth, $1.00. 

FO UR TH EDITION— RE VISED. 

Synopsis of Contents. — The Pelvis and Genital Organs — 
Signs of Pregnancy — Management of Pregnancy — Accidents of 
Pregnancy — Germs and Antisepsis — Application of Antisepsis to 
Confinement Nursing — Preparations for the Labor — Signs of 
Approaching Labor and the Process of Labor — Duties of the Nurse 
during Labor — Accidents and Emergencies of Labor — Care of the 
New-born Infant — Management of the Lying-in — Characteristics of 
Infancy in Health and Disease — The Ailments of Early Infancy — 
Index. 

" It is a book that I have recommended since I first saw it, and we are using 
it for our nurses at the N. Y. Infirmary, where we have a branch of our School, 
our nurses going there for instruction in obstetrics." — Mrs. L. W. Quintard, 
Supt. Connecticut Training School for Nurses, New Haven, Conn. 

"It is the most modern and complete book I have ever read for the care of 
obstetrical patients. I shall take pleasure in recommending it to this school for 
study." — E. L. Warr, Supt. Training School for Nurses, City Hospital, St. 
Louis, Mo. 

" I have looked it over and read it with care, and think it is the best book I 
have ever seen on the subject. It is practical, with plain instructions, nothing 
superfluous. A good book for nurses and teachers of nurses."— Miss Anna 
G. Clement. Supt. of Nurses, The Henry W. Bishop Memorial Training 
School for Nurses, Pittsfield, Mass. 

" I consider the book excellent in every particular. Would recommend it to 
every nurse, whether she did obstetrical nursing or not." — Gertrude Mont- 
fort, Suf>t of Nurses, New England Hospital for Women and Children^ 
Boston, Mass. 

" What is to be learned in a maternity training school is the way to nurse as a 
profession. * * * Can recommend it as a valuable manual."— From the Amer* 
ica n Jou ma 1 of Medical Sciences. 



BOOKS ON NURSING. 



SHAWE. Notes for Visiting Nurses, and all 

those Interested in the Working and Organization of 
District, Visiting, or Parochial Nurse Societies. By 
Rosalind Gillette Shawe, District Nurse for the 
Brooklyn Red Cross Society. With an Appendix 
explaining the Organization and Workings of various 
Visiting and District Nurse Societies, by Helen C. 
Jenks, of Philadelphia. i2mo. Cloth, $1.00 

"A sensibly written, useful little manual is the ' Notes for Visiting Nurses/ 
by Rosalind Gillette Shawe, a district nurse for the Red Cross Society in Brook- 
lyn. Compact, concise, practical, the advice in every detail is most excellent. 
The book is written for two classes of readers — the district nurse, who is in need 
of timely cautions and hints, and for those who would willingly uphold the hands 
of the workers did they but understand what the work really is. A valuable 
appendix gives information concerning the organization of societies for district 
nursing, and brief descriptions of those already in operation." — The Christian 
Advocate, New York. 

CULLINGWORTH. A Manual of Nursing, 
Medical and Surgical. By Charles J. Cul- 
lingworth, m.d., Physician to St. Mary's Hospital, 
Manchester, England. Third Edition. With 18 
Illustrations. T2mo. Cloth, .75 

BY THE SAME AUTHOR. 

A Manual for Monthly Nurses. Third Edi- 
tion. 32mo. Cloth, .40 

" This small volume is written as a supplement to the author's well-known 
work on nursing. It treats only of the conditions of pregnancy and labor. It 
is clear in its statements, and will prove of great value to those whose duty it 
is to care for women during and after confinement." — N. Y. Medical Journal. 

DOMVILLE. Manual for Nurses and Others 
Engaged in Attending to. the Sick. By Ed. J. Dom- 
ville, m.d. Eighth Edition. With Directions for 
Bandaging, Preparing and Administering Enemata, 
Fomentations, Poultices, Baths, etc., Recipes for 
Sick-room Cookery, Tables of Weights, and a Com- 
plete Glossary of Medical Terms. Cloth, .75 



BOOKS ON NURSING. 



CANFIELD. The Hygiene of the Sick-Room. 

A Book for Nurses and Others, being a Brief Consid- 
eration of Asepsis, Disinfection, Bacteriology, Im- 
munity, Heating and Ventilation, and Kindred Sub- 
jects, for the use of Nurses and Other Intelligent 
Women. By Wm. Buckingham Canfield, a.m., 
m.d., Lecturer on Clinical Medicine, and Chief of 
Chest Clinic, University of Maryland, Visiting Phy- 
sician to Bay View Hospital, etc. i2mo. 247 pages. 
Handsome Cloth Binding, $1.25 

*%* This book is the outcome of a series of lectures delivered by 
Dr. Canfield at the University of Maryland Training School for 
Nurses. It contains much valuable information not included in the 
regular text-books, but which of. necessity the nurse should be ac- 
quainted with. 

"We recommend it to the attention, not ODly of sick-nurses, but also all other 
persons, of either sex, who desire a knowledge of the behavior of disease, as it 
concerns infection ; and the manner in which foulness, either of wounded sur- 
faces, or of the sick-room, or of the dwelling-house, may be prevented. 

" Each disease is taken up in turn (typhoid fever, consumption, diphtheria, 
etc.) and the methods of management of the discharges, etc., are described in 
detail. The formulae for the preparation of disinfecting solutions, for clothing, 
utensils, privies, etc., are clearly set forth; such details as one may search his 
library in vain for are here given in a compact form. 

" The prevention of blindness in infants receives full attention. Ventilation 
is duly considered, and a chapter is given to the thoughtful discussion of immu- 
nity and protection from disease. The book closes with some remarks upon 
the diet of the sick-room. We congratulate Dr. Canfield on his work. It is 
well worth the moderate price." — Maryland Medical Journal. 

WESTLAND. The Wife and Mother. A 

Medical Guide to the Care of her Health and the 
Management of her Children. By Albert West- 
land, m.d. i2mo. Illustrated. Cloth, #1.50 

From The Medical News. 

" . . . Altogether the book fulfils the objects for which it was written, 
and will materially assist the young married woman in the intelligent perform- 
ance of new duties." 

From The Nurse, Boston. 

" The style is easy and fascinating. It should be in the hands of every nurse 
and married woman." 



BOOKS ON MASSAGE. 



KLEEN. Handbook of Massage. Cloth, $2.25 
By Dr. Kleen, of Stockholm and Carlsbad. Translated 
by Edward M. Hartwell, a.m. m.d., Director of Physi- 
cal Education, Boston Public Schools, late of Johns Hop- 
kins University, Baltimore. With an introduction by S. 
Weir Mitchell, m.d., of Philadelphia. Illustrated by a 
series of Handsome Engravings, made from fine Pen-and- 
ink Drawings after original photographs made for the pur- 
pose. *#* This is the American Edition of "Kleen's Hand- 
book," which is well known among teachers and experts 
as the most comprehensive and perfect on the subject. 
Several changes and additions have been made at the 
author's suggestion, notably among the latter the set of 
illustrations made from photographs taken by him for this 
eaition. No pains have been spared to make this the best 
of standard works upon massage. 

MURRELL. Massotherapeutics. Fourth Edi- 
tion. Or Massage as a Mode of Treatment. By Wm. 
Murrell, m.d., f.r.c.p., Lecturer on Pharmacology and 
Therapeutics at Westminster Hospital, Examiner at Uni- 
versity of Edinburgh, Physician to Royal Hospital for Dis- 
eases of the Chest. Fifth Edition. Revised and Enlarged. 
Illustrated. i2mo. Cloth, 1.25 

"Dr. Murrell particularly dwells on the importance of discrimination in the 
selection of cases and on the special qualifications of a competent manipulator. 
In a word, this essay may be said to convey in a short space most of the infor- 
mation that is at present available in regard to this popular therapeutic agent. " 
— From the London Practitioner. 

" This little volume sets forth clearly all the advantages and disadvantages 
of massage at the present day, and should be in the hands of every Masseuse 
or nurse intending to take up the art. The numerous illustrations of the move- 
ments will prove a great aid. " — From the Trained Nurse . 



BOOKS ON MASSAGE. 



Massage and the Original Swedish Move- 
ments. Illustrated. And Their Application to 
Various Diseases of the Body. A Manual for Students, 
Nurses, and Physicians. By Kurre W. Ostrom, 
from the Royal University of Upsala, Sweden ; In- 
structor in Massage and Swedish Movements in the 
Hospital of the University of Pennsylvania and in 
the Philadelphia Polyclinic and College for Graduates 
in Medicine, etc. Illustrated by ninety-three ex- 
planatory Wood Engravings. Third Edition, Revised 
and Enlarged. i2mo. Cloth, $1.00 

" Mr. Ostrom presents to the English public this excellent, systematic manual, 
showing, by illustrations, the various movements and the mode of application to 
all parts of the body. The writer tells for what diseases such movements are 
indicated, with some remarks on the physiology of the movement treatment." 
—From The Philadelphia Public Ledger. 

" In this volume the author gives an excellent description of the methods oi 
massage and Swedish movement, together with their applicability to various 
diseased conditions of the body. The methods are rapidly becoming popular- 
ized in our own country, and the perusal of such a book as Mr. Ostrom has 
written will be of great advantage to physicians, for whose use it is mainly in- 
tended." — From the Journal of the American Medical Association. 

WARD, Notes on Massage; Including Ele- 
mentary Anatomy and Physiology. By Jessie 
M. Ward, Instructor in Massage in the Pennsylvania, 
Philadelphia, Jefferson, and Woman's Hospitals, 
Clinical Lecturer at Philadelphia Polyclinic. 121110. 
Interleaved. Paper cover, #1.00 



SURGICAL NURSING. 



BY BERTHA M. VOSWINKEL, 

Graduate of the Episcopal Hospital ', Philadelphia ; Nurse -in- Charge of 
Children' s Hospital, Columbus, O. 



INCLUDING COMPLETE CHAPTERS ON 

BANDAGING, DRESSINGS, 

SPLINTS, ETC. 

in Illustrations. i2mo. 168 Pages. Cloth, $1.00. 



Synopsis of Contents. — I. Introduc- 
tion, Care of Patient, Bed, and Room, etc. 
— II. Qualifications of Surgical Nurse, 
General" Examination, and Care of Patient 
— III. Antiseptics and Antiseptic Surgery 
— IV. Antiseptic Dressings — V and VI. 
Gynecological Nursing — VII and VIII. 
Hemorrhages — IX. Fractures and Dislo- 
cations — X. Special Cases — XL Ban- 
daging — XII. Fixed Dressings — XIII. 
Splints and Braces -XIV. Massage- ^JULtf/^jT 
Appendix A. Invalid Cookery — Appen- Nursing-. 

dix B. Enemas, Ice Poultice, Excessive Perspiration, Weights and 
Measures, Poisons, etc. — Index. 




From the Chicago Medical Recorder. 

"The book is eminently practical and concise. The author's style and 
methods are excellent." 



BOOKS FOR NURSES. 



HORWITZ'S Surgery. Minor Surgery and 
Bandaging. Fifth Edition. 167 Illustrations. 

A Compend of Surgery, including Minor Surgery, 
Amputations, Fractures, Dislocations, Surgical Dis- 
eases, Antiseptic Rules, Formulae, etc., with Differen- 
tial Diagnosis and Treatment, and a Complete Section 
on Bandaging. By Orville Horwitz, b.s., m.d., 
Professor of Genito-Urinary Diseases ; late Demonstra- 
tor of Surgery, Jefferson Medical College, etc. Fifth 
Edition. 324 pages. 121110. Cloth, .80 

*x* The new Section on Bandaging and Surgical Dress- 
ings consists of 34 Pages and 40 Illustrations. Ever)! 
Bandage of any importance is Figured. 

POTTER'S Anatomy. Sixth Edition. 117 
Illustrations and 16 Lithograph Plates. A 

Compend of Human Anatomy. By Saml. O. L. 
Potter, m.a , m.d., m.r.c.p. (Lond.), Professor of 
the Practice of Medicine, Cooper Medical College, 
San Francisco. 121110. Cloth, .80 

POTTER'S Materia Medica, Therapeutics, 
and Prescription Writing. Sixth Edition. 

Compend of Materia Medica, Therapeutics, and Pre- 
scription Writing. With special reference to the Phy- 
siological Action of Drugs. By Samuel O. L. Potter, 
m.a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon, 
U. S. Army ; Professor of the Practice of Medicine, 
Cooper Medical College, San Francisco. i2mo. 

Cloth, .80 

BRUBAKER'S Physiology. Ninth Edition, 
Enlarged and Improved. Illustrated. A Com- 
pend of Physiology, including Embryology. By 
A. P. Brubaker, m.d., Demonstrator of Physiology 
at Jefferson Medical College ; Professor of Physiology, 
Pennsylvania College of Dental Surgery, Philadelphia. 
28 Illustrations. 1 21110. Cloth, .80 



NEW EDITION. 

ACCIDENTS and EMERGENCIES. 

A Manual for the treatment of Surgical and other Injuries, 
Poisoning and various Domestic Emergencies, in the absence of the 
Physician. 



By CHARLES W. DULLES, M.D., 

Surgeon to the Out-Door Department of the University and Presbyterian 
Hospitals , Philadelphia. 



Fifth Edition, Enlarged. 



New Illustrations. 12mo. 
ILLUSTRATED. 



Cloth, $1.00 



SHORT LIST OF CONTENTS. 



Preliminary Remarks. 
Obstructions to Respiration. 
Foreign Bodies in the Eye, Nose and 

Ear. 
Fits or Seizures. 
Injuries to the Brain. 
Effects of Heat and Cold. 
Flectricity, Accidents caused by. 
Sprains. 
Dislocations. 
Fractures. 
Wounds of all kinds, including the 

bites of Dogs, Cats, Snakes, Insects, 

etc. 
Railroad and Machinery Accidents. 



Hemorrhage — Bleeding. 

Special Hemorrhages. 

Transportation of the Injured. 

Poisons and their Antidotes. 

Domestic Emergencies, includes Chol- 
era Morbus, Vomiting, Diarrhoea, 
Nervous Attacks, Earache, Tooth- 
ache, Asthmatic Attacks, Croup, 
etc., etc. 

Signs of Death. 

Supplies for Emergencies. 

The Surgical and Medicine Case, 
their contents and use, Bandaging, 
Poultices, etc. 

Index. 



of a 



*£* This book should be in the possession of every head 
family, Nurse, Manufacturer, Police Lieutenant, Sea Captain, Hos- 
pital Steward, School Teacher, Druggist, etc. etc. 

" Several attempts have been made to prepare a volume which would serve 
as a handy manual for reference in the time of need, in the absence of a doctor, 
but none have succeeded better than the present little work. It should be in the 
hands of all officers charged with the public conveyance of passengers, to be 
read, in preparation for emergencies, and afterward to serve as a book of refer- 
ence." —North Carolina Medical Journal. 

" 1 his little manual contains simple directions for the preliminary treatment 
of accidents to all parts of the body and of such diseases as persons are suddenly 
seized with. Without profuseness or an unintelligible vocabulary, it contains in 
a small space a deal of useful information." — Nexv York World. 

" This is a revised and enlarged edition, with new illustrations, of the manual, 
explaining the treatment of surgical and other injuries in the absence of the phy- 
sician. The simple and practical suggestions of this little book should be known 
to every one. Accidents are constantly occurring, and a knowledge of what 
should be done in an emergency is very valuable. Such a handbook should be 
in every home, placed where it can always be found readily. — Boston Journal 
of Education, 



NURSES' CHARTS 



GRIFFITH'S Temperature Charts. A concise, 
complete Record of Pulse, Respiration, Temperature, 
etc. Packets of fifty, 50 cents 

KEEN'S Clinical Charts. A Series of Outline 
Drawings of the Human Body, on which may be 
marked the Course of Disease, Fractures, Operations, 
etc. Pads of fifty, $1.00 

SCHREINER'S Diet List. Arranged in the Form 
of a Chart, on which Articles of Diet may be indi- 
cated for any Disease. Pads of fifty, 75 cents 

BROWN. 

ELEMENTARY PHYSIOLOGY 

FOR NURSES, 

BY FLORENCE HAIG-BROWN, 

* St. Thomas' Hospital, London. 

21 Illustrations. 12mo. Cloth, 75 Cents. 

Based upon the Lectures given to nurses by the Medical Officers 
of St. Thomas' Hospital. 



LECTURES ON MEDICINE 

TO NURSES, 

BY HERBERT CUFF, M. D., 

Assistant Medical Officer Southwestern Fever Hospital, London. 

Second Edition. 12mo. Illustrated. Cloth, $1.25. 

Synopsis of Contents. — Infection — Use of Stimulants — 
Feeding — The Pulse — Inflammation — Pneumonia — Enteric Fever — 
Scarlet Fever — Diphtheria — Measles — Whooping Cough — Paralysis 
— Hysteria — Internal Hemorrhages — Massage— Precautions in In 
fectious Disease. 



THE 



American Health Primers. 

EDITED BY W. W. KEEN, M.D., 

Professor of Surgery in the Jefferson Medical College, Fellow of the College 
of Physicians of Philadelphia, etc. 



12 Vols. 32mo. Attractive Cloth Binding, each 40 Cents. 

This Series of Health Primers is prepared to diffuse as widely and 
cheaply as possible, among all classes, a knowledge of the elementary facts of 
Preventive Medicine. They are intended incidentally to assist in curing dis- 
eases, and to teach people how to form correct habits of living, and take care 
of themselves, their children, employees, etc. 

I. HEARING AND HOW TO KEEP IT. With Illustrations. By Chas. 
H. Burnett, m,d., of Philadelphia, Aurist to the Presbyterian Hospital. 

H. LONG LIFE AND HOW TO REACH IT. By J. G. Richardson, m.d., 
of Philadelphia, late Professor of Hygiene in the University of Pennsyl- 
vania. 

III. THE SUMMER AND ITS DISEASES. By James C. Wilson, m.d., 
of Philadelphia, Professor of the Practice of Medicine, Jefferson Medical 
College. 

IV. EYESIGHT AND HOW TO CARE FOR IT. With Illustrations. By 
George C. Harlan, m.d., of Philadelphia, Surgeon to the Wills (Eye) 
Hospital. 

V. THE THROAT AND THE VOICE. With Illustrations. By J. Solis 
Cohen, m.d., of Philadelphia, Lecturer on Diseases of the Throat in Jef- 
ferson Medical College, and on the Voice in the National School of Oratory. 

VI. THE WINTER AND ITS DANGERS. By Hamilton Osgood, m.d., 

of Boston, Editorial Staff Boston Medical and Surgical Journal. 

VII. THE MOUTH AND THE TEETH. With Illustrations. By J. W. 
White, m.d., d.d.s., of Philadelphia, Editor of the Dental Cosmos. 

VIII. BRAIN WORK AND OVERWORK. By H. C. Wood, Jr., m.d., of 
Philadelphia, Clinical Professor of Nervous Diseases in the University of 
Pennsylvania. 

IX. OUR HOMES. With Illustrations. By Henry Hartshorne, m.d., 
of Philadelphia, formerly Professor of Hygiene in the University of Penn- 
sylvania. 

X. THE SKIN IN HEALTH AND DISEASE. With Illustrations. By 
L. D. Bulkley, m.d., of New York, Physician to the Skin Department 
of the New York Hospital. 

XI. SEA AII^ AND SEA BATHING. With Illustrations. By John H. 
Packard, m.d., of Philadelphia, Surgeon to the Pennsylvania Hospital. 

XII. SCHOOL AND INDUSTRIAL HYGIENE. By D. F. Lincoln, m.d.. 
of Boston, Mass., Chairman Department of Health, American Social 
Science Association. 

" The series of 'American Health Primers ' deserves hearty commendation. 
These handbooks of practical suggestions are prepared by men whose profes- 
sional competence is beyond question, and, for the most part, by those who 
have made the subject treated the study of their lives." — New York Sun. 

%* Each Volume 40 Cents, in Attractive Cloth Binding. 



THE 

Hygiene of the Nursery 

INCLUDING THE GENERAL REGIMEN AND FEEDING OF INFANTS 

AND CHILDREN AND THE DOMESTIC MANAGEMENT 

OF THE ORDINARY EMERGENCIES OF 

EARLY LIFE. 

BY LOUIS STARR, M. D., 

Clinical Professor of Diseases of Children in the Hospital of the University 
of Pennsylvania; Physician to the Children's Hospital, Phila. 

Sixth Edition. Enlarged and improved. 

WITH TWENTY-FIVE ILLUSTRATIONS. 

i2mo. 280 Pages. Cloth, $1.00. 



*^*This book contains very complete directions for the prop.r 
feeding of infants : 1st, From the maternal breast. 2d. By wet- 
nur^e, including rules for choosing the woman. 3d, Artificial 
Feeding. This part of the subject is elaborated carefully, so as to 
include everything of importance, and will be found of great service 
to the monthly nurse. General and specific rules for feeding are 
given, and Diet Lists from the first week up to the eighteenth 
month, with various recipes for artificial foods, peptonized milk, etc. 
Directions for the sterilization of milk, substitutes for milk, prepara- 
tion of food for both well and sick children, nutritious enemata. 
etc., and the general management of the Nursery. 

" Dr. Starr's experience as Clinical Professor of Diseases of Children in the 
University Hospital and as physician to the Children's Hospital, with his 
eminence in private practice among juvenile patients, is ample warranty for the 
satisfaction and instruction to be found in this book. The dedication " To my 
Little Patients," shows the sympathy with which the writer enters upon the 
important discussion. The volume is entirely in the modern lines of preventive 
medicine — more important in the nursery than at any other time of life ; because 
constitution building is going on then and there. In this admirable treatise, so 
clearly written that no mother need be deterred by fear of medical terms from 
making its teaching her own. Dr. Starr carries out the highest ideal of fhe 
modern physician, so to regulate the lives of his professional clients that the 
occasions are less frequent when he need be called in to act for serious compli- 
cations. * * * * With the numerous good treatises on the subject that 
Philadelphia publications include, this intelligent work is the most distinguished, 
as it is also the latest work on complete Hygiene of the Nursery." — The Led- 
ger, Philadelphia. 



A NEW EDITION, JUST READY. 



GOULD'S POCKET MEDICAL LEXICON. 



21,000 MEDICAL WORDS 



PRONOUNCED AND DEFINED. 



A Pronouncing Lexicon of Medical Words Specially Adapted for 
Nurses, Including Many Useful Tables and a Dose List* 



BY GEORGE M. GOULD, M.D.. 



- 



Author of "An Illustrated Dictionary of Medi- 
cine, Biology, and Allied Sciences," "The 
Student's Medical Dictionary," etc. 

Pocket Size. 522 Pages. Gilt Edges, 

Full Morocco. Price $1.00; with 

a Thumb Index, $1.25. 



OVER 85,000 COPIES OF GOULD'S 

DICTIONARIES HAVE BEEN SOLD. 



" Gould's Dictionary, Pocket Edition, is the most complete and convenient I 
have seen." — Marion E. Smith, Head Nurse , Philadelphia Hospital, Phila. 



*' The Pocket Dictionary is a little gem. 
General Hospital. 



■L. J. Gross, Head Nurse, Buffalo 



" I have examined Gould's Dictionary, and consider it the bes' ' uionary in 
a small compass that I have seen. The price, too, is most reason, I shall 

recommend it to all our nurses." — F. Hutcheson, Head Nurse, FL .t r Mission 
Training School for Nurses, Indianapolis , Ind. 

** 1 shall certainly have the nurses each send for a copy of the dictionary. It 
is just what they need, and is a nice size to carry." — Harriet Sutherland, Head, 
Nurse, Margaret Pillsbury Hospital, Concord, N. H. 



Every nurse should have a copy of this little book in order 
to intelligently pursue her studies and to thoroughly understand 
the physician's directions. It furnishes a vast amount of informa- 
tion not to be obtained in the regular text-books. 



FEB S3 I 899 



